=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861699589
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HANY WILLIAMS DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4361 S SUNCOAST BLVD
-----------------------------------------------------
City | HOMOSASSA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34446-1181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-628-7788
-----------------------------------------------------
Fax | 352-628-7772
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4361 S SUNCOAST BLVD
-----------------------------------------------------
City | HOMOSASSA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34446-1181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-628-7788
-----------------------------------------------------
Fax | 352-628-7772
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN16259
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------