Leonard David Williams IV, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10491 Issued in NC

Practice address

621A N Fodale Ave
Southport, NC 28461-3550

Phone

(910) 363-1695

NPI assigned

Aug 30, 2016

Last updated

Aug 30, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Leonard David Williams IV DDS-PC

  dba Southport Dental

  • Dental Clinic/Center
  • Southport, NC
  • NPI 1922782218
  NPD Authorized official

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

{
    "created_epoch": "1472515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472515200000",
    "number": "1538615414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4013 NORSEMAN LOOP UNIT 5",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284611010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621A N FODALE AVE",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284613550",
            "telephone_number": "910-363-1695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "LEONARD",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-30",
        "last_updated": "2016-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "10491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Larry Felix Weisner, MD
• Amy Elizabeth Weisse, DPT
• Victoria Wessell, OTR/L
• Jeffrey W Wickline, OTR/L
• Jennifer S. Williams, DDS
• Wilmington Health PLLC
• Wilmington Orthopaedic Group
• Steven Douglas Wilson, MD
• Harrietthall Hall Witherspoon, COTA/L
• Womack Army Medical Center (Occ HLTH NSG Off-Sunny Point)

• General Practice Dentistry in Southport, NC
• Providers in Southport, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2016; 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.