Provider Demographics
NPI:1801991799
Name:WILLIAMS, BRYAN JACK (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JACK
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 SAND POINT WAY NE
Mailing Address - Street 2:M/S CD
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3901
Mailing Address - Country:US
Mailing Address - Phone:206-987-2243
Mailing Address - Fax:206-987-3891
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:M/S CD
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-2243
Practice Address - Fax:206-987-3891
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000072851223X0400X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0130118Medicaid
WA5100011Medicaid
AKDD103WAMedicaid
ID03556700Medicaid