Larry Nolan Williams Jr., DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-026064 Issued in IL

Practice address

3001 6TH St Ste a
Naval Health Clinic, Building 237
Great Lakes, IL 60088-2833

Phone

(847) 688-3331

Fax

(847) 688-6259

NPI assigned

Jan 25, 2006

Last updated

Feb 27, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Sep 25, 2015 through Sep 25, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361923200000",
    "number": "1972573624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4934 LUNT AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600773538",
            "telephone_number": "847-975-3767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 6TH ST STE A",
            "address_2": "NAVAL HEALTH CLINIC, BUILDING 237",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "600882833",
            "telephone_number": "847-688-3331",
            "fax_number": "847-688-6259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "LARRY",
        "middle_name": "NOLAN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2013-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401008558",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-026064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannan Jesse Walker, DDS
• William Roy Welder, M.D.
• James Allen Westra, M.D.
• Lauren Wiles, DMD
• Rhonda Wiley, IDC
• Roberta Ellen Wisun, DDS
• Shauna Wittke, RDH
• Walter R Wittke, DDS
• Joseph Phillip Yancho, DDS
• Joseph B. Youkhana, M.D.

• General Practice Dentistry in Great Lakes, IL
• Providers in Great Lakes, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.