Provider Demographics
NPI:1376282202
Name:WILLIAMSON, KALEB (DDS)
Entity type:Individual
Prefix:DR
First Name:KALEB
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 PINEY CV
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7461
Mailing Address - Country:US
Mailing Address - Phone:318-557-7102
Mailing Address - Fax:
Practice Address - Street 1:2929 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3204
Practice Address - Country:US
Practice Address - Phone:225-372-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA73431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice