Provider Demographics
NPI:1134235492
Name:WILLIAMSON, THOMAS C (DDS)
Entity type:Individual
Prefix:PROF
First Name:THOMAS
Middle Name:C
Last Name:WILLIAMSON
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 1:1112 N VAN BUREN AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6416
Mailing Address - Country:US
Mailing Address - Phone:641-684-6889
Mailing Address - Fax:641-684-3886
Practice Address - Street 1:1112 N VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6416
Practice Address - Country:US
Practice Address - Phone:641-684-6889
Practice Address - Fax:641-684-3886
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA72531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0093252Medicaid