Provider Demographics
NPI:1992065965
Name:WILLIAMSON, KEVIN PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PAUL
Last Name:WILLIAMSON
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 1:409 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:MN
Mailing Address - Zip Code:56267-1601
Mailing Address - Country:US
Mailing Address - Phone:320-589-4481
Mailing Address - Fax:
Practice Address - Street 1:2 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1344
Practice Address - Country:US
Practice Address - Phone:320-589-4481
Practice Address - Fax:320-589-2750
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist