Provider Demographics
NPI:1265107627
Name:WILLIAMS FAMILY AND COSMETIC DENTISTRY
Entity type:Organization
Organization Name:WILLIAMS FAMILY AND COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-689-5098
Mailing Address - Street 1:510 VONDERBURG DR SUITE 211
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5979
Mailing Address - Country:US
Mailing Address - Phone:813-689-5098
Mailing Address - Fax:
Practice Address - Street 1:510 VONDERBURG DR SUITE 211
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5979
Practice Address - Country:US
Practice Address - Phone:813-689-5098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental