Provider Demographics
NPI:1821464421
Name:WILLIAMS, JOSHUA (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 E LABRADOR BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-3996
Mailing Address - Country:US
Mailing Address - Phone:620-266-3636
Mailing Address - Fax:
Practice Address - Street 1:2033 E LABRADOR BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-3996
Practice Address - Country:US
Practice Address - Phone:620-266-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9444507-9921122300000X
KS617621223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist