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NPI Code Detail

MEDICARE: DR. DEANDRA ALEXANDRIA WILLIAMS DDS

MEDICARE: DR. DEANDRA ALEXANDRIA WILLIAMS DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistD15488MN

General Provider Information

NPI Number : 1730022807
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEANDRA ALEXANDRIA WILLIAMS DDS
Provider Business Mailing Address
First Line : 8170 33RD AVE S
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55425-4516
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 205 WABASHA ST S
Second Line :
City : SAINT PAUL
State : MN
Zip : 55107-1805
Country : US
Telephone Number : 651-293-8100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 06/18/2026

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