Provider Demographics
NPI:1437286804
Name:WILLIAMS, RUSSELL CLARK JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:CLARK
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 1:621 LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-8756
Mailing Address - Country:US
Mailing Address - Phone:701-662-5008
Mailing Address - Fax:
Practice Address - Street 1:621 LAKE VIEW DR
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-8756
Practice Address - Country:US
Practice Address - Phone:701-662-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND19701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice