Healthcare Provider Details

I. General information

NPI: 1265107627
Provider Name (Legal Business Name): WILLIAMS FAMILY AND COSMETIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 VONDERBURG DR SUITE 211
BRANDON FL
33511-5979
US

IV. Provider business mailing address

510 VONDERBURG DR SUITE 211
BRANDON FL
33511-5979
US

V. Phone/Fax

Practice location:
  • Phone: 813-689-5098
  • Fax:
Mailing address:
  • Phone: 813-689-5098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TREVOR WILLIAMS
Title or Position: OWNER/PRESIDENT
Credential: DMD
Phone: 813-689-5098