Provider Demographics
NPI:1720126220
Name:WILLIAMS, GREGORY P (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
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 1:330 E STUMER RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6406
Mailing Address - Country:US
Mailing Address - Phone:605-348-3400
Mailing Address - Fax:605-348-1626
Practice Address - Street 1:330 E STUMER RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6406
Practice Address - Country:US
Practice Address - Phone:605-348-3400
Practice Address - Fax:605-348-1626
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM8081223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8000390Medicaid
SDU50866Medicare UPIN
SD3519Medicare ID - Type Unspecified