Provider Demographics
NPI:1073586228
Name:T MERRELL WILLIAMS DMD MS PA
Entity Type:Organization
Organization Name:T MERRELL WILLIAMS DMD MS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:MERRELL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:813-354-8707
Mailing Address - Street 1:4505 N ARMENIA AVE
Mailing Address - Street 2:#101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603
Mailing Address - Country:US
Mailing Address - Phone:813-354-8707
Mailing Address - Fax:813-354-9230
Practice Address - Street 1:4505 N ARMENIA AVE
Practice Address - Street 2:#101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603
Practice Address - Country:US
Practice Address - Phone:813-354-8707
Practice Address - Fax:813-354-9230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN128101223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty