Provider Demographics
NPI:1104896125
Name:WILLIAMS, BRANDON HEATH (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:HEATH
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 MEDICAL GROUP UNIT 3215
Mailing Address - Street 2:RAMSTEIN AB
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09094
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:86 MEDICAL GROUP UNIT 3215
Practice Address - Street 2:RAMSTEIN AB
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09094
Practice Address - Country:US
Practice Address - Phone:637-146-2609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84601223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice