Provider Demographics
NPI:1477037703
Name:WILLIAMS, CHASE JEFFERY (DDS)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:JEFFERY
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 1:853 4TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:MN
Mailing Address - Zip Code:56097-1407
Mailing Address - Country:US
Mailing Address - Phone:801-318-7941
Mailing Address - Fax:
Practice Address - Street 1:150 3RD ST NW
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:MN
Practice Address - Zip Code:56097-1021
Practice Address - Country:US
Practice Address - Phone:507-553-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-22
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND141101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice