Individual
DR. AVI WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MAST
Contact information
Practice address
135 SAXONY RD, ENCINITAS, CA 92024-3791
(760) 634-5437
Mailing address
6155 RADCLIFFE DR, SAN DIEGO, CA 92122-3311
(570) 332-0689
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
22DI02765200
NJ
1223P0221X
Pediatric Dentistry
Primary
DDS102334
CA
1223P0221X
Pediatric Dentistry
DS040383
PA
Other
Enumeration date
06/15/2015
Last updated
11/09/2021
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