Provider Demographics
NPI:1730240961
Name:WILLIAMS, MARK ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROBERT
Last Name:WILLIAMS
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 1:11020 E 10TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3710
Mailing Address - Country:US
Mailing Address - Phone:317-898-9231
Mailing Address - Fax:317-898-9245
Practice Address - Street 1:11020 E 10TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3710
Practice Address - Country:US
Practice Address - Phone:317-898-9231
Practice Address - Fax:317-898-9245
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120079591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice