Shane Anthony Williams, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

9943 Issued in KY

Practice address

1802 Rockingham Ave
Bowling Green, KY 42104-3348

Phone

(270) 783-0064

Fax

(270) 901-1997

NPI assigned

Jul 31, 2008

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 2, 2024 through May 2, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1217462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1437315272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1938 LYDA AVENUE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "42104",
            "telephone_number": "270-783-0064",
            "fax_number": "270-901-1997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 ROCKINGHAM AVE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421043348",
            "telephone_number": "270-783-0064",
            "fax_number": "270-901-1997"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2400 Patterson Street",
            "address_2": "Suite 316",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372036510",
            "country_code": "US",
            "telephone_number": "615-327-3534",
            "fax_number": "615-327-3552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "SHANE",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-31",
        "last_updated": "2022-07-21",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "KY",
            "license": "9943",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OK",
            "license": "332",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "9422",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "9943",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1528342",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Dawn Williams, CSW
• Kaylee Williams
• Kaylee Maletta Williams, PHARMD, RPH
• Krista Lou Williams
• Neil Williams
• Amanda Leona Williamson
• Kayla Williamson, MD
• Chad Willis, M.D.
• Jana Willis, MS RD LDN
• Jayna Nichole Willis, M.S. CCC-SLP

• Oral and Maxillofacial Surgery (Dentist) in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Oral and Maxillofacial Surgery (Dentist) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.