Provider Demographics
NPI:1457721912
Name:WILLIAMS, RYAN (DDS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
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 1:402 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:MI
Mailing Address - Zip Code:49310-9120
Mailing Address - Country:US
Mailing Address - Phone:989-561-2865
Mailing Address - Fax:
Practice Address - Street 1:402 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:MI
Practice Address - Zip Code:49310-9120
Practice Address - Country:US
Practice Address - Phone:989-561-2865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16117122300000X
MI2901601124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist