Healthcare Provider Details

I. General information

NPI: 1104896125
Provider Name (Legal Business Name): BRANDON HEATH WILLIAMS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 SAINT JOHNS BLVD
JOPLIN MO
64804-1884
US

IV. Provider business mailing address

3001 SAINT JOHNS BLVD
JOPLIN MO
64804-1884
US

V. Phone/Fax

Practice location:
  • Phone: 417-208-0805
  • Fax:
Mailing address:
  • Phone: 417-208-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2026010607
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2026010607
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: