Provider Demographics
NPI:1306376512
Name:WILLIAMS, SEAN THERON (DMD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:THERON
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:SEAN
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:13576 NW 2ND LN STE 30
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-3736
Mailing Address - Country:US
Mailing Address - Phone:352-354-3601
Mailing Address - Fax:
Practice Address - Street 1:13576 NW 2ND LN STE 30
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-3736
Practice Address - Country:US
Practice Address - Phone:352-354-3601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN225731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice