Provider Demographics
NPI:1396720884
Name:WILLIAMS, JAY CHRISTOPHER (DDS)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:CHRISTOPHER
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 1:2218 LAUREL AVE
Mailing Address - Street 2:MILL CITY DENTAL
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-1909
Mailing Address - Country:US
Mailing Address - Phone:612-377-3740
Mailing Address - Fax:612-377-5004
Practice Address - Street 1:2218 LAUREL AVE
Practice Address - Street 2:MILL CITY DENTAL
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-1909
Practice Address - Country:US
Practice Address - Phone:612-377-3740
Practice Address - Fax:612-377-5004
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND111591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice