Provider Demographics
NPI:1477334514
Name:WILLIAMS, TAMMY Y
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:Y
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MICHAEL CT
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-2564
Mailing Address - Country:US
Mailing Address - Phone:216-695-7025
Mailing Address - Fax:
Practice Address - Street 1:26407 BENTON AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-2519
Practice Address - Country:US
Practice Address - Phone:216-695-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHEFDA002693126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant