Active NPI
Williams Dental South
- General Practice Dentistry
- Red Oak, TX
National Provider Identifier
1194807578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8495
- Legal business name
- WILLIAMS DENTAL SOUTH
- Practice address
- 269 E. Ovilla Rd.
Ste: 300
Red Oak, TX 75154 - Phone
- (972) 576-0248
- Fax
- (972) 576-0346
- NPI assigned
- Oct 19, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Charles Ivan Williams Sr., DDS
- Title
- Dentist
- Phone
- (972) 576-0248
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8495 | TX | Primary |
Addresses
Primary practice location
269 E. Ovilla Rd.
Ste: 300
Red Oak, TX 75154
Mailing address
269 E. Ovilla Rd.
Box 300
Red Oak, TX 75154
Phone (972) 576-3603
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 148102001 | Medicaid | TX | |
| 0079JM | Other | TX | BLUE CROSS BLUE SHIELD |
| 01364233 | Other | TX | UNITED CONCORDIA |
| 1039831 | Other | TX | UNITED HEALTHCARE |
National Provider Directory
National Provider Directory- Tax ID family
- Williams Dental Associates Southpc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Oral and Maxillofacial Surgery (Dentist)
- Ferris, TX
- NPI 1235300872
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1418947200000",
"number": "1194807578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "269 E. OVILLA RD.",
"address_2": "BOX 300",
"city": "RED OAK",
"state": "TX",
"postal_code": "75154",
"telephone_number": "972-576-3603",
"fax_number": "972-576-3664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "269 E. OVILLA RD.",
"address_2": "STE: 300",
"city": "RED OAK",
"state": "TX",
"postal_code": "75154",
"telephone_number": "972-576-0248",
"fax_number": "972-576-0346"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WILLIAMS DENTAL SOUTH",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-19",
"last_updated": "2014-12-19",
"status": "A",
"authorized_official_last_name": "WILLIAMS",
"authorized_official_first_name": "CHARLES",
"authorized_official_middle_name": "IVAN",
"authorized_official_title_or_position": "DENTIST",
"authorized_official_telephone_number": "972-576-0248",
"authorized_official_name_prefix": "Dr.",
"authorized_official_name_suffix": "Sr.",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "8495",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "148102001",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0079JM",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "01364233",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1039831",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Red Oak, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.