Provider Demographics
NPI:1639325731
Name:WILLIAMS, ROLAND PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:PAUL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 970
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-0970
Mailing Address - Country:US
Mailing Address - Phone:909-258-9263
Mailing Address - Fax:909-543-4211
Practice Address - Street 1:1655 N MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1427
Practice Address - Country:US
Practice Address - Phone:909-258-9263
Practice Address - Fax:909-543-4211
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA592611223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery