Provider Demographics
NPI:1912076001
Name:WILLIAMS, GRANT R (DMD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:PACIFIC CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97135
Mailing Address - Country:US
Mailing Address - Phone:503-965-0014
Mailing Address - Fax:503-965-3637
Practice Address - Street 1:38505 BROOTEN RD
Practice Address - Street 2:STE B
Practice Address - City:PACIFIC CITY
Practice Address - State:OR
Practice Address - Zip Code:97135
Practice Address - Country:US
Practice Address - Phone:503-965-0014
Practice Address - Fax:503-965-3637
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist