Healthcare Provider Details

I. General information

NPI: 1700860145
Provider Name (Legal Business Name): JOHN C WILLIAMS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CENTRAL AVE NAVAL HEALTH CLINIC HAWAII
PEARL HARBOR HI
96860
US

IV. Provider business mailing address

480 CENTRAL AVE NAVAL HEALTH CLINIC HAWAII
PEARL HARBOR HI
96860
US

V. Phone/Fax

Practice location:
  • Phone: 757-672-1923
  • Fax:
Mailing address:
  • Phone: 757-672-1923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019-023877
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: