Williams, Shane Anthony
Williams, Shane Anthony is an sole proprietor health care provider with primary practice located at 1802 Rockingham Ave , Bowling Green KY 42104-3348. He recently has 2 registered licenses in different health care specialties including Dental Providers / Oral and Maxillofacial Pathology, Dental Providers / Oral and Maxillofacial Surgery. Dental Providers / Oral and Maxillofacial Surgery is his primary health care specialty. Williams, Shane Anthony can be contacted via phone (270) 783-0064.Contact Information
Primary practice address
1802 Rockingham Ave
Bowling Green KY 42104-3348
Phone: (270) 783-0064
Fax: (270) 901-1997
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Pathology | 1223P0106X | 9943 | Kentucky |
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 332 | Oklahoma |
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 9422 | Tennessee |
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 9943 | Kentucky |
Profile Details
| NPI number | 1437315272 |
|---|---|
| LBN Legal business name | Williams, Shane Anthony |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 31st, 2008 |
| Last updated | Jul 21st, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1437315272 | NPPES |
| Tennessee | MEDICAID | 1528342 |
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