Provider Demographics
NPI:1558596148
Name:WILLIAMS ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:WILLIAMS ORTHODONTICS, PLLC
Other - Org Name:WILLIAMS ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:303-670-5878
Mailing Address - Street 1:32156 CASTLE CT
Mailing Address - Street 2:SUITE #207
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9517
Mailing Address - Country:US
Mailing Address - Phone:303-670-5878
Mailing Address - Fax:303-670-5879
Practice Address - Street 1:32156 CASTLE CT
Practice Address - Street 2:SUITE #207
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9517
Practice Address - Country:US
Practice Address - Phone:303-670-5878
Practice Address - Fax:303-670-5879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8404261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental