Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 2901018137 | MI |
NPI | 1073578498 |
---|---|
Provider Name | Dr. Bryan Arthur Williams |
First Address | Travis Afb, CA 94535-1809 |
Second Address | Travis Afb, CA 94535-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 11/03/2020 |