Individual provider Active NPI

Philip Dwight Williams II, DDS

  • Dentist
  • Depew, NY
National Provider Identifier
1104073964
Registry record updated Feb 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
054074 Issued in NY
Practice address
6350 Transit Rd
Depew, NY 14043-1039
Phone
(716) 206-0718
NPI assigned
Aug 25, 2008
Last updated
Feb 6, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 054074 NY Primary

Addresses

Primary practice location

6350 Transit Rd
Depew, NY 14043-1039

Mailing address

6350 Transit Rd
Depew, NY 14043-1039
Phone (716) 206-0718

Other identifiers 1

IdentifierTypeStateIssuer
03096375MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160513000930 NY Order and Referring Only - DentistPractitioner - Dentist 7214226273

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
054074NYMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770336000000",
    "number": "1104073964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6350 TRANSIT RD",
            "city": "DEPEW",
            "state": "NY",
            "postal_code": "140431039",
            "telephone_number": "716-206-0718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6350 TRANSIT RD",
            "city": "DEPEW",
            "state": "NY",
            "postal_code": "140431039",
            "telephone_number": "716-206-0718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "PHILIP",
        "middle_name": "DWIGHT",
        "name_suffix": "II",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-25",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "054074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03096375",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Depew, NY

Sources for this page

Verify at the official NPI Registry.