Provider Demographics
NPI:1407029648
Name:WILLIAMS, PAUL EUGENE JR (DDS)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:EUGENE
Last Name:WILLIAMS
Suffix:JR
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 1:2065 AIRWAY AVE
Mailing Address - Street 2:STE A
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409
Mailing Address - Country:US
Mailing Address - Phone:928-757-1707
Mailing Address - Fax:928-757-3070
Practice Address - Street 1:2065 AIRWAY AVE
Practice Address - Street 2:STE A
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409
Practice Address - Country:US
Practice Address - Phone:928-757-1707
Practice Address - Fax:928-757-3070
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3582122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist