Active NPI
Jerry B Williams, DDS
- General Practice Dentistry
- Brush Prairie, WA
National Provider Identifier
1881164762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4684
- Practice address
- 24121 NE 124TH Circle
Brush Prairie, WA 98606-4322 - Phone
- (360) 260-6934
- NPI assigned
- Dec 4, 2018
- Sex
- Male
- Sole proprietor
- Yes
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 | 4684 | WA | Primary |
Addresses
Primary practice location
24121 NE 124TH Circle
Brush Prairie, WA 98606-4322
Mailing address
24121 NE 124TH Cir
Brush Prairie, WA 98606-4322
Phone (360) 260-6934
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 |
|---|---|---|---|
| 4684 | WA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1543881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543881600000",
"number": "1881164762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24121 NE 124TH CIR",
"city": "BRUSH PRAIRIE",
"state": "WA",
"postal_code": "986064322",
"telephone_number": "360-260-6934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24121 NE 124TH CIRCLE",
"city": "BRUSH PRAIRIE",
"state": "WA",
"postal_code": "986064322",
"telephone_number": "360-260-6934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "JERRY",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-12-04",
"last_updated": "2018-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "4684",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brush Prairie, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.