Kevin Paul Williamson, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

D13075 Issued in MN

Practice address

2 E 5TH St
Morris, MN 56267-1344

Phone

(320) 589-4481

Fax

(320) 589-2750

NPI assigned

May 23, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dental Depot, LLC

  • Dentist
  • Morris, MN
  • NPI 1285022145
  NPD (past) Authorized official
• Dental Depot Inc

  • Dentist
  • Morris, MN
  • NPI 1831254150
  NPD (past)

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

{
    "created_epoch": "1337731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370476800000",
    "number": "1992065965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 BIRCH AVE",
            "city": "MORRIS",
            "state": "MN",
            "postal_code": "562671601",
            "telephone_number": "320-589-4481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 E 5TH ST",
            "city": "MORRIS",
            "state": "MN",
            "postal_code": "562671344",
            "telephone_number": "320-589-4481",
            "fax_number": "320-589-2750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMSON",
        "first_name": "KEVIN",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-23",
        "last_updated": "2013-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olyn R Wernsing, MD
• West Central Internal Medicine
• West Central Smiles PA
• West Wind Village
• Lisa Marie Williams, FNP
• Jackie Marie Wilt, PHARM.D
• Winmar Diagnostics North Central
• Christopher Dean Wolner, D.C.

• All providers in Morris, MN
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.