Provider Demographics
NPI:1295005494
Name:MCWILLIAMS, KELLI (DDS)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:MCWILLIAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 WALNUT AVE SUITE E
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501
Mailing Address - Country:US
Mailing Address - Phone:970-243-2025
Mailing Address - Fax:970-243-2027
Practice Address - Street 1:132 WALNUT AVE STE E
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7483
Practice Address - Country:US
Practice Address - Phone:970-243-2025
Practice Address - Fax:970-243-2027
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice