Provider Demographics
NPI:1639377955
Name:WILLIAMS, MITCHELL JARED (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:JARED
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 1:7129 E PEAKIVEW PLACE
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4621
Mailing Address - Country:US
Mailing Address - Phone:303-221-0059
Mailing Address - Fax:
Practice Address - Street 1:9085 E MINERAL CIR STE 220
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3400
Practice Address - Country:US
Practice Address - Phone:303-798-1068
Practice Address - Fax:303-798-1538
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND124591223G0001X
CODEN-94831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice