Bruce Mosby Williams, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

2025012199 Issued in MO

Practice address

1759 17TH Ave E
Shakopee, MN 55379-3372

Phone

(217) 540-8250

NPI assigned

Aug 17, 2006

Reactivated

Sep 30, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769731200000",
    "number": "1609989961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8603 NORTH OAK TRAFFIC WAY",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "64155",
            "telephone_number": "405-627-9113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1759 17TH AVE E",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553793372",
            "telephone_number": "217-540-8250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3177 E 146th Pl S",
            "address_purpose": "LOCATION",
            "city": "Bixby",
            "state": "OK",
            "postal_code": "740088046",
            "country_code": "US",
            "telephone_number": "405-627-9113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "BRUCE",
        "middle_name": "MOSBY",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2026-01-30",
        "certification_date": "2026-01-30",
        "deactivation_date": "2022-09-15",
        "reactivation_date": "2022-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2025012199",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D15402",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "4946",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joelle Elise Weir, CNP
• Charles Bernard Wenner, DDS
• Brittany Werre, LICSW
• Mark Westholder
• Ann Elizabeth Williams, DC
• Danelle Williams, MSW LICSW
• Daniel Deforest Williams
• Kalee Williams, MA, LMFT
• Deanin Savon Willsun, LPCC
• Amy J Wilma, M.A.-CCC/SLP

• Dentist in Shakopee, MN
• Providers in Shakopee, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2026; 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.