Provider Demographics
NPI:1982827952
Name:WILLIAMS, BRAD J (DDS)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:J
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 1:1180 N OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5920
Mailing Address - Country:US
Mailing Address - Phone:208-888-3311
Mailing Address - Fax:208-888-1691
Practice Address - Street 1:1180 N OLIVE AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5920
Practice Address - Country:US
Practice Address - Phone:208-888-3311
Practice Address - Fax:208-888-1691
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD32201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice