Individual
ALAN D. WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1915 BROADWAY ST, MOUNT VERNON, IL 62864-2980
(618) 242-5600
Mailing address
13340 BRIDGEFORD AVE, BONITA SPRINGS, FL 34135-3489
(238) 495-7782
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
19A12643
IL
Other
Enumeration date
05/14/2007
Last updated
07/08/2007
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