Provider Demographics
NPI:1508395203
Name:WINDHAM, WILLIAM TRAVIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TRAVIS
Last Name:WINDHAM
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 1:5701 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-7814
Mailing Address - Country:US
Mailing Address - Phone:850-763-8030
Mailing Address - Fax:
Practice Address - Street 1:5701 HICKORY ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-7814
Practice Address - Country:US
Practice Address - Phone:850-763-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL226641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice