Provider Demographics
NPI:1124052709
Name:WILLIAMS, GREGORY A (DMD, PC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11820 SW KING JAMES PL
Mailing Address - Street 2:SUITE #40
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-2480
Mailing Address - Country:US
Mailing Address - Phone:503-620-2020
Mailing Address - Fax:503-624-5796
Practice Address - Street 1:11820 SW KING JAMES PL
Practice Address - Street 2:SUITE #40
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-2480
Practice Address - Country:US
Practice Address - Phone:503-620-2020
Practice Address - Fax:503-624-5796
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD74671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice