Provider Demographics
NPI:1609989961
Name:WILLIAMS, BRUCE MOSBY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MOSBY
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 1:3177 E 146TH PL S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-8046
Mailing Address - Country:US
Mailing Address - Phone:405-627-9113
Mailing Address - Fax:
Practice Address - Street 1:3177 E 146TH PL S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-8046
Practice Address - Country:US
Practice Address - Phone:405-627-9113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2022-09-30
Deactivation Date:2022-09-15
Deactivation Code:
Reactivation Date:2022-09-30
Provider Licenses
StateLicense IDTaxonomies
OK49461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice