Individual
MARY E. WILLIARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1245 FULTON AVE, COOS BAY, OR 97420-2895
(541) 888-6433
Mailing address
1245 FULTON AVE, COOS BAY, OR 97420-2895
(541) 888-6433
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1151
AK
122300000X
Dentist
D11929
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500797447
—
OR
05
—
DD16151
—
AK
Enumeration date
02/23/2007
Last updated
10/14/2024
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