Provider Demographics
NPI:1942223722
Name:WILLIAMS, BRYAN (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32156 CASTLE CT
Mailing Address - Street 2:SUITE 211
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9517
Mailing Address - Country:US
Mailing Address - Phone:303-670-5878
Mailing Address - Fax:303-670-5879
Practice Address - Street 1:32156 CASTLE CT
Practice Address - Street 2:SUITE 211
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9517
Practice Address - Country:US
Practice Address - Phone:303-670-5878
Practice Address - Fax:303-670-5879
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics