Provider Demographics
NPI:1629165543
Name:WILLIAMS, TARIN THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:TARIN
Middle Name:THOMAS
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 1:222 W PORTER ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261-8629
Mailing Address - Country:US
Mailing Address - Phone:270-526-8500
Mailing Address - Fax:270-526-8555
Practice Address - Street 1:222 W PORTER ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-8629
Practice Address - Country:US
Practice Address - Phone:270-526-8500
Practice Address - Fax:270-526-8555
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY82661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60003803Medicaid