Individual
SUSAN WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1629 N 45TH ST, SEATTLE, WA 98103-6701
(206) 633-3350
(206) 633-3113
Mailing address
1200 12TH AVE S, SUITE 901, SEATTLE, WA 98144-2712
(206) 548-3114
(206) 762-6355
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00009739
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5046412
—
WA
Enumeration date
11/08/2006
Last updated
01/22/2016
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