Organization
WILLIAMS ORAL AND MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY P WILLIAMS DDS (OWNER)
(605) 348-3400
Entity
Organization
Contact information
Practice address
330 E STUMER RD, RAPID CITY, SD 57701-6406
(605) 348-3400
(605) 348-1626
Mailing address
330 E STUMER RD, RAPID CITY, SD 57701-6406
(605) 348-3400
(605) 348-1626
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
M808
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003519
BLUE CROSS BLUE SHIELD
—
01
—
690846
UNITED CONCORDIA
—
05
—
8000390
—
SD
Enumeration date
03/26/2008
Last updated
03/26/2008
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