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General NPI Number Information
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NPI Number | 1003341934
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Entity Type | Organization
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Legal Business Name | TREVOR A WILLIAMS DMD PC
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 400 S GOLD AVE
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City | DEMING
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State | NM
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Zip | 88030-4159
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Country | US
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Telephone | 575-546-2684
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Fax | 575-546-1106
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Provider Business Mailing Address
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Address Line | 400 S GOLD AVE
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City | DEMING
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State | NM
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Zip | 88030-4159
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Country | US
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Telephone | 575-546-2684
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Fax | 575-546-1106
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Authorized Official
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Title or Position | FINANCIAL COORDINATOR
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Name | SAMANTHA K JASSO
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Credential |
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Telephone | 575-546-2684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DD2677
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License Number State | NM
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