Active NPI
Randall Edward Williams, DDS
- General Practice Dentistry
- Valparaiso, IN
National Provider Identifier
1700950516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12009730
- Practice address
- 800 Wall St
Suite C
Valparaiso, IN 46383-2564 - Phone
- (219) 531-0459
- Fax
- (219) 464-9656
- NPI assigned
- Nov 20, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12009730 | IN | Primary |
Addresses
Primary practice location
800 Wall St
Suite C
Valparaiso, IN 46383-2564
Mailing address
800 Wall St
Suite C
Valparaiso, IN 46383-2564
Phone (219) 531-0459
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 799250 | Other | UNITED CONCORDIA INS |
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 |
|---|---|---|---|
| 12009730 | IN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1700950516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 WALL ST",
"address_2": "SUITE C",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463832564",
"telephone_number": "219-531-0459",
"fax_number": "219-464-9656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 WALL ST",
"address_2": "SUITE C",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463832564",
"telephone_number": "219-531-0459",
"fax_number": "219-464-9656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "RANDALL",
"middle_name": "EDWARD",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "12009730",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA INS",
"identifier": "799250",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Valparaiso, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.