NPIMap

Organization Active NPI

Robert L Williamson III DDS 4 PA

  • General Practice Dentistry
  • Raleigh, NC
National Provider Identifier
1093850992
Registry record updated Oct 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7038 Issued in NC
Legal business name
ROBERT L WILLIAMSON III DDS 4 PA
Practice address
119 N Boylan Ave
Raleigh, NC 27603-1445
Phone
(919) 828-3775
NPI assigned
Feb 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nancy Campbell
Title
Operation Director
Phone
(919) 828-3775

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 7038 NC Primary

Addresses

Primary practice location

119 N Boylan Ave
Raleigh, NC 27603-1445

Mailing address

PO Box 10401
Raleigh, NC 27605-0401
Phone (919) 828-3775

Other identifiers 1

IdentifierTypeStateIssuer
5902049MedicaidNC

Other names 1

  • Raleigh Comprehensive & Cosmetic Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

119 N Boylan Ave
Raleigh, NC 27603
Phone (919) 522-7720

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444780800000",
    "number": "1093850992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10401",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276050401",
            "telephone_number": "919-828-3775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 N BOYLAN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276031445",
            "telephone_number": "919-828-3775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT L WILLIAMSON III DDS 4 PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2015-10-14",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "OPERATION DIRECTOR",
        "authorized_official_telephone_number": "919-828-3775"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "7038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902049",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Raleigh Comprehensive & Cosmetic Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.