William Kenneth Tom, D.D.S., M.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

37747 Issued in CA

Practice address

620 S Dora St
Suite 205
Ukiah, CA 95482-5466

Phone

(707) 462-6983

NPI assigned

Apr 23, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wandell Dental Corporation

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Ukiah, CA
  • NPI 1407601164
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720206899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 S DORA ST",
            "address_2": "SUITE 205",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954825466",
            "telephone_number": "707-462-6983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 S DORA ST",
            "address_2": "SUITE 205",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954825466",
            "telephone_number": "707-462-6983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOM",
        "first_name": "WILLIAM",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "37747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rendy Timberlake
• Nicole Tobin
• Jodi Todd, R.D.H.A.P.
• Shannon Cross Todd, FNP
• Troyle Tognoli
• Lorenzo Gabriel Torres
• Nanci Elizabeth Torres
• Jessica Toste, LVN
• Jenny My Tran, PHARM.D.
• Phuc Cong Tran, DMD

• Oral and Maxillofacial Surgery (Dentist) in Ukiah, CA
• Providers in Ukiah, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.