Active NPI
Stephen Kyle Williams, DDS
- Dentist
- Forest Lake, MN
National Provider Identifier
1619469236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D14026
- Practice address
- 1068 Lake St S Ste 209
Forest Lake, MN 55025-2634 - Phone
- (505) 402-5808
- Fax
- (651) 464-9050
- NPI assigned
- May 30, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D14026 | MN | Primary |
Addresses
Primary practice location
1068 Lake St S Ste 209
Forest Lake, MN 55025-2634
Mailing address
1068 Lake St S Ste 209
Forest Lake, MN 55025-2634
Phone (505) 402-5808
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D14026 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527638400000",
"number": "1619469236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1068 LAKE ST S STE 209",
"city": "FOREST LAKE",
"state": "MN",
"postal_code": "550252634",
"telephone_number": "505-402-5808",
"fax_number": "651-464-9050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1068 LAKE ST S STE 209",
"city": "FOREST LAKE",
"state": "MN",
"postal_code": "550252634",
"telephone_number": "505-402-5808",
"fax_number": "651-464-9050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "STEPHEN",
"middle_name": "KYLE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-30",
"last_updated": "2018-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D14026",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.