Healthcare Provider Details

I. General information

NPI: 1295956043
Provider Name (Legal Business Name): ROBERT SCOTT WILLIAMS R. PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBERT SCOTT WILLIAMS D.D.S.

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EUCLID ST
GRANDVIEW WA
98930-1160
US

IV. Provider business mailing address

90 SUMMIT DRIVE
GRANDVIEW WA
98930-9736
US

V. Phone/Fax

Practice location:
  • Phone: 509-882-3151
  • Fax: 509-882-2603
Mailing address:
  • Phone: 509-840-7770
  • Fax: 509-882-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5973
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00010451
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: