Provider Demographics
NPI:1275609026
Name:WILLIAMS, RONALD WESLEY (DDS DENTIST)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:WESLEY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS DENTIST
Other - Prefix:
Other - First Name:RONALD
Other - Middle Name:WESLEY
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS DENTIST
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63302-0697
Mailing Address - Country:US
Mailing Address - Phone:636-723-3993
Mailing Address - Fax:636-723-4044
Practice Address - Street 1:200 SOUTH KINGS HIGHWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:ST CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1637
Practice Address - Country:US
Practice Address - Phone:636-723-3993
Practice Address - Fax:636-723-4094
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist