Healthcare Provider Details

I. General information

NPI: 1780678466
Provider Name (Legal Business Name): THOMAS P WILLIAMS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BRYANT ST
DUBUQUE IA
52003-7405
US

IV. Provider business mailing address

100 BRYANT ST
DUBUQUE IA
52003-7405
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-1440
  • Fax: 563-557-7001
Mailing address:
  • Phone: 563-557-1440
  • Fax: 563-557-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number05935
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5000989015
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number23154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: