Healthcare Provider Details

I. General information

NPI: 1518966696
Provider Name (Legal Business Name): RICHARD WILLIAMS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

315 EDISON AVE
ALAMOSA CO
81101-2580
US

IV. Provider business mailing address

PO BOX 1841
ALAMOSA CO
81101-1841
US

V. Phone/Fax

Practice location:
  • Phone: 719-589-3686
  • Fax:
Mailing address:
  • Phone: 719-589-3686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number104042
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: