Provider Demographics
NPI:1053388280
Name:WILLIAMSON, MORTON MADISON (DDS)
Entity type:Individual
Prefix:DR
First Name:MORTON
Middle Name:MADISON
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 1:9137 COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-1969
Mailing Address - Country:US
Mailing Address - Phone:540-582-6247
Mailing Address - Fax:540-582-3527
Practice Address - Street 1:9137 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-1969
Practice Address - Country:US
Practice Address - Phone:540-582-6247
Practice Address - Fax:540-582-3527
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010053621223G0001X
VA0202004868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered183500000XPharmacy Service ProvidersPharmacist