Provider Demographics
NPI:1205921897
Name:WILLIAMS, DOUGLAS P (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:P
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2220 N. MOORPARK RD.
Mailing Address - Street 2:101
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3168
Mailing Address - Country:US
Mailing Address - Phone:805-497-1004
Mailing Address - Fax:805-497-2024
Practice Address - Street 1:2220 N. MOORPARK RD.
Practice Address - Street 2:101
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3168
Practice Address - Country:US
Practice Address - Phone:805-497-1004
Practice Address - Fax:805-497-2024
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA383811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics