Provider Demographics
NPI:1821047614
Name:WILLIAMS, KURT ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:ALLEN
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 1:202 N DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:67439-3216
Mailing Address - Country:US
Mailing Address - Phone:785-472-3803
Mailing Address - Fax:785-472-3620
Practice Address - Street 1:202 N DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:KS
Practice Address - Zip Code:67439-3216
Practice Address - Country:US
Practice Address - Phone:785-472-3803
Practice Address - Fax:785-472-3620
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS66521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice