Provider Demographics
NPI:1821162702
Name:WILLIAMS, THOMAS GENTRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GENTRY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3524
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74101-3524
Mailing Address - Country:US
Mailing Address - Phone:918-425-1376
Mailing Address - Fax:
Practice Address - Street 1:4618 N FRANKFORT AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74126-3217
Practice Address - Country:US
Practice Address - Phone:918-425-1376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist