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Individual
DR. SHAUN WILLIS
Active
Individual
DR. SHAUN WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
27076
TX
332B00000X
Durable Medical Equipment & Medical Supplies
27076
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27076
TEXAS DENTAL LICENSE
TX
Enumeration date
06/28/2011
Last updated
10/15/2018
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