Vincent L Williams, DMD,PA

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D1658-OS Issued in ID

Practice address

590 Falls Ave
Twin Falls, ID 83301-3314

Phone

(208) 734-3562

Fax

(208) 736-8339

NPI assigned

Feb 12, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322438400000",
    "number": "1376685982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 FALLS AVE",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013314",
            "telephone_number": "208-734-3562",
            "fax_number": "208-736-8339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 FALLS AVE",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013314",
            "telephone_number": "208-734-3562",
            "fax_number": "208-736-8339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "VINCENT",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DMD,PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2011-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ID",
            "license": "D1658-OS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805148000",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001226500",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001226600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keri Nicole Williams, LMSW
• Monte Paul Williams, DDS
• Spencer Geyer Williams, DC
• Tiara Mae Williams, LMSW
• Troy Alan Williams, DDS MDS
• Neelie Berlin Willis, PA-C
• Willow Creek Physical & Sports Therapy
• Willowbrook LLC
• Erika L Willsey
• Mallory Antonetta Wilson, SUDA

• Oral and Maxillofacial Surgery (Dentist) in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Oral and Maxillofacial Surgery (Dentist) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.