Organization
DAVID WILLIS DMD, LLC
Active
Other names
Willis Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID G WILLIS D.M.D. (DENTIST)
(503) 364-3004
Entity
Organization
Contact information
Practice address
1261 LANCASTER DR NE, SALEM, OR 97301-1959
(503) 364-3004
(503) 364-1623
Mailing address
1261 LANCASTER DR NE, SALEM, OR 97301-1959
(503) 364-3004
(503) 364-1623
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
D7786
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841395977
DAVID G. WILLIS, DMD
OR
Enumeration date
08/10/2016
Last updated
09/30/2016
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