Provider Demographics
NPI:1407842685
Name:WILLIAMS, TOM MARTIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:MARTIN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-3117
Mailing Address - Country:US
Mailing Address - Phone:808-778-8805
Mailing Address - Fax:
Practice Address - Street 1:343 HOPE BAY LOOP
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-3533
Practice Address - Country:US
Practice Address - Phone:843-730-3418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4368122300000X, 1223G0001X
FL677122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice