Provider Demographics
NPI:1679207617
Name:WILLIAMS, JOSHUA LEE (LD)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25052 104TH AVE SE STE G
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6853
Mailing Address - Country:US
Mailing Address - Phone:253-813-8000
Mailing Address - Fax:
Practice Address - Street 1:25052 104TH AVE SE STE G
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6853
Practice Address - Country:US
Practice Address - Phone:253-813-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61205665122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist