Provider Demographics
NPI:1568806487
Name:WILLIAMS DENTAL & ORTHODONTICS, PC
Entity Type:Organization
Organization Name:WILLIAMS DENTAL & ORTHODONTICS, PC
Other - Org Name:WILLIAMS DENTAL, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-645-1928
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-0338
Mailing Address - Country:US
Mailing Address - Phone:918-396-3711
Mailing Address - Fax:918-396-1062
Practice Address - Street 1:1400 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-3927
Practice Address - Country:US
Practice Address - Phone:918-396-3711
Practice Address - Fax:918-396-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6215122300000X
122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty