Provider Demographics
NPI:1740343953
Name:DRS WILLIAMS & WIMMER DDS PA
Entity type:Organization
Organization Name:DRS WILLIAMS & WIMMER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-559-4778
Mailing Address - Street 1:9800 ROCKFORD RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-2811
Mailing Address - Country:US
Mailing Address - Phone:763-559-4778
Mailing Address - Fax:763-383-2976
Practice Address - Street 1:9800 ROCKFORD RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-2811
Practice Address - Country:US
Practice Address - Phone:763-559-4778
Practice Address - Fax:763-383-2976
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRS WILLIAMS & WIMMER DDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-18
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN96751223G0001X
MND96291223G0001X
MND96751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty