Provider Demographics
NPI:1619469236
Name:WILLIAMS, STEPHEN KYLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KYLE
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 1:1068 LAKE ST S STE 209
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2634
Mailing Address - Country:US
Mailing Address - Phone:505-402-5808
Mailing Address - Fax:651-464-9050
Practice Address - Street 1:1068 LAKE ST S STE 209
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2634
Practice Address - Country:US
Practice Address - Phone:505-402-5808
Practice Address - Fax:651-464-9050
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist