Individual
DR. WILLIS GILSON CARDOT JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2609 W 8TH ST, ERIE, PA 16505-4022
(814) 833-3703
Mailing address
2609 W 8TH ST, ERIE, PA 16505-4022
(814) 833-3703
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS022416L
PA
174400000X
Specialist
DS022416L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1027786760001
—
PA
Enumeration date
07/27/2006
Last updated
12/15/2015
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