Healthcare Provider Details

I. General information

NPI: 1407842685
Provider Name (Legal Business Name): TOM MARTIN WILLIAMS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 HOPE BAY LOOP
APOLLO BEACH FL
33572-3533
US

IV. Provider business mailing address

11 MIDWAY DR
HONOLULU HI
96818-3117
US

V. Phone/Fax

Practice location:
  • Phone: 843-730-3418
  • Fax:
Mailing address:
  • Phone: 808-778-8805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4368
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4368
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number677
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: