Provider Demographics
NPI:1598827412
Name:WILLIAMS, GARY VINCENT JR (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:VINCENT
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11335 W BUCKEYE RD
Mailing Address - Street 2:SUITE #101 C
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-6814
Mailing Address - Country:US
Mailing Address - Phone:602-284-9194
Mailing Address - Fax:480-963-1627
Practice Address - Street 1:8538 E CACTUS WREN CIR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-1334
Practice Address - Country:US
Practice Address - Phone:602-284-9194
Practice Address - Fax:480-963-1627
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4924122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist