Healthcare Provider Details

I. General information

NPI: 1477334514
Provider Name (Legal Business Name): TAMMY Y WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26407 BENTON AVE
EUCLID OH
44132-2519
US

IV. Provider business mailing address

201 MICHAEL CT
PAINESVILLE OH
44077-2564
US

V. Phone/Fax

Practice location:
  • Phone: 216-695-7025
  • Fax:
Mailing address:
  • Phone: 216-695-7025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberEFDA002693
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: