Provider Demographics
NPI:1437258902
Name:WILLIAMS, RICHARD LEROY (DMD, PHD, MS, MBA)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEROY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DMD, PHD, MS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3599 WINFIELD SCOTT ROAD
Mailing Address - Street 2:BUILDING 2841, ROOM 3309
Mailing Address - City:JBSA-FSH
Mailing Address - State:TX
Mailing Address - Zip Code:78234
Mailing Address - Country:US
Mailing Address - Phone:210-221-7714
Mailing Address - Fax:
Practice Address - Street 1:3145 GARDEN AVENUE
Practice Address - Street 2:SUITE 1278
Practice Address - City:JOINT BASE SAN ANTONIO - FSH
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-295-4095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010088481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics