Provider Demographics
NPI:1427269133
Name:WILLIAMS, BRENDA (DMD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:IVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 1900
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-1900
Mailing Address - Country:US
Mailing Address - Phone:360-376-4774
Mailing Address - Fax:
Practice Address - Street 1:469 NORTHBEACH RD
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-1900
Practice Address - Country:US
Practice Address - Phone:360-376-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE78841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice