Provider Demographics
NPI:1821207127
Name:WILLIAMS, THOMAS O
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:O
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 N DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-3249
Mailing Address - Country:US
Mailing Address - Phone:937-890-4820
Mailing Address - Fax:937-890-4225
Practice Address - Street 1:6800 N DIXIE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3249
Practice Address - Country:US
Practice Address - Phone:937-890-4820
Practice Address - Fax:937-890-4225
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH147461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice