Provider Demographics
NPI:1548271968
Name:WILLIAMSON, MICHAEL SCOTT (DDS,MS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 N MO PAC EXPY STE 210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-2698
Mailing Address - Country:US
Mailing Address - Phone:512-346-2782
Mailing Address - Fax:512-346-7284
Practice Address - Street 1:7200 N MO PAC EXPY STE 210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2698
Practice Address - Country:US
Practice Address - Phone:512-346-2782
Practice Address - Fax:512-346-7284
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX167511223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics