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General NPI Number Information
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NPI Number | 1083597603
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Entity Type | Individual
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Provider Name | JUSTIN PATRICK WILLSON DDS
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Gender | Male
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Dates
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Enumeration Date | 07/30/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 489 FORKS OF THE RIVER PKWY
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City | SEVIERVILLE
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State | TN
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Zip | 37862-3422
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Country | US
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Telephone | 865-453-0032
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Fax | 865-378-8636
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Provider Business Mailing Address
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Address Line | 489 FORKS OF THE RIVER PKWY
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City | SEVIERVILLE
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State | TN
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Zip | 37862-3422
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Country | US
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Telephone | 865-453-0032
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Fax | 865-378-8636
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12852
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License Number State | TN
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