Provider Demographics
NPI:1972573624
Name:WILLIAMS, LARRY NOLAN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:NOLAN
Last Name:WILLIAMS
Suffix:JR
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 1:4934 LUNT AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3538
Mailing Address - Country:US
Mailing Address - Phone:847-975-3767
Mailing Address - Fax:
Practice Address - Street 1:3001 6TH ST STE A
Practice Address - Street 2:NAVAL HEALTH CLINIC, BUILDING 237
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-2833
Practice Address - Country:US
Practice Address - Phone:847-688-3331
Practice Address - Fax:847-688-6259
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010085581223G0001X
IL019-0260641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice