Provider Demographics
NPI:1558353482
Name:WILLIAMS, BRADFORD RAYMOND (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:RAYMOND
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:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-5090
Mailing Address - Country:US
Mailing Address - Phone:918-396-3711
Mailing Address - Fax:918-396-1062
Practice Address - Street 1:1400 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-3927
Practice Address - Country:US
Practice Address - Phone:918-396-3711
Practice Address - Fax:918-396-1062
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:2006-04-03
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
OK43931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice