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General NPI Number Information
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NPI Number | 1609397389
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Entity Type | Individual
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Provider Name | BRANDON LEE WILLIAMS DMD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2017
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 1735 S PUBLIC RD
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City | LAFAYETTE
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State | CO
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Zip | 80026-7093
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Country | US
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Telephone | 303-650-4460
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Fax |
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Provider Business Mailing Address
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Address Line | 203 S ROLLIE AVE
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City | FORT LUPTON
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State | CO
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Zip | 80621-1508
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Country | US
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Telephone | 303-892-6401
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Fax | 303-286-4589
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN.00204293
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 33090
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License Number State | TX
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