Provider Demographics
NPI:1255344990
Name:WILLIAMS, KERRY BRENT (DDS)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:BRENT
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 1:1006 HOBBS HWY
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-3322
Mailing Address - Country:US
Mailing Address - Phone:432-758-9839
Mailing Address - Fax:432-758-2668
Practice Address - Street 1:1006 HOBBS HWY
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3322
Practice Address - Country:US
Practice Address - Phone:432-758-9839
Practice Address - Fax:432-758-2668
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice