Provider Demographics
NPI:1407466337
Name:WILLIAMS, KANDIS CARTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:KANDIS
Middle Name:CARTER
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL HEALTH CLINIC HAWAII
Mailing Address - Street 2:480 CENTRAL AVENUE
Mailing Address - City:PEARL HARBOR
Mailing Address - State:HI
Mailing Address - Zip Code:96860
Mailing Address - Country:US
Mailing Address - Phone:225-210-8595
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HEALTH CLINIC HAWAII
Practice Address - Street 2:480 CENTRAL AVENUE
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860
Practice Address - Country:US
Practice Address - Phone:225-210-8595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.0006765-C1122300000X
VA04014174401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist