Provider Demographics
NPI:1003341934
Name:TREVOR A WILLIAMS DMD PC
Entity Type:Organization
Organization Name:TREVOR A WILLIAMS DMD PC
Other - Org Name:DEMING DENTAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:JASSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-546-2684
Mailing Address - Street 1:400 S GOLD AVE
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-4159
Mailing Address - Country:US
Mailing Address - Phone:575-546-2684
Mailing Address - Fax:575-546-1106
Practice Address - Street 1:400 S GOLD AVE
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4159
Practice Address - Country:US
Practice Address - Phone:575-546-2684
Practice Address - Fax:575-546-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2677261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental