Provider Demographics
NPI:1336479054
Name:WILLIAMS, KIRK C (DDS)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:C
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 1:2600 N 20TH AVE
Mailing Address - Street 2:MS T-1
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301
Mailing Address - Country:US
Mailing Address - Phone:509-542-4571
Mailing Address - Fax:509-544-2023
Practice Address - Street 1:2600 N 20TH AVE
Practice Address - Street 2:T-1
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301
Practice Address - Country:US
Practice Address - Phone:509-542-4571
Practice Address - Fax:509-544-2023
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000044161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice