Provider Demographics
NPI:1467664524
Name:WILLIAMS, MARK G (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4450 CORDOVA ST
Mailing Address - Street 2:STE 130
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7210
Mailing Address - Country:US
Mailing Address - Phone:907-562-1686
Mailing Address - Fax:907-563-6484
Practice Address - Street 1:4450 CORDOVA ST
Practice Address - Street 2:STE 130
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7210
Practice Address - Country:US
Practice Address - Phone:907-562-1686
Practice Address - Fax:907-563-6484
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AKAA0411223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics