Provider Demographics
NPI:1144694878
Name:COLLEEN WILLIAMS DDS PC
Entity type:Organization
Organization Name:COLLEEN WILLIAMS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:OM
Authorized Official - Phone:505-881-8979
Mailing Address - Street 1:10409 MONTGOMERY PKWY NE STE 202
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3862
Mailing Address - Country:US
Mailing Address - Phone:505-881-8979
Mailing Address - Fax:505-888-1003
Practice Address - Street 1:10409 MONTGOMERY PKWY NE STE 202
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3862
Practice Address - Country:US
Practice Address - Phone:505-881-8979
Practice Address - Fax:505-888-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD1870122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM14750503Medicaid