Individual
DR. NANCY WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DS 027099-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012201610001
—
PA
01
—
669980
UNITED CONCORDIA
PA
01
—
DS 027099-L
PA STATE DENTAL LICENSE
PA
Enumeration date
12/31/2006
Last updated
03/02/2020
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