Provider Demographics
NPI:1205026887
Name:WILLIAMS, RICHARD L (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
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 1:515 N SEPULVEDA BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6748
Mailing Address - Country:US
Mailing Address - Phone:310-318-5512
Mailing Address - Fax:310-798-7359
Practice Address - Street 1:515 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6748
Practice Address - Country:US
Practice Address - Phone:310-318-5512
Practice Address - Fax:310-798-7359
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist