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General NPI Number Information
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NPI Number | 1104074525
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Entity Type | Individual
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Provider Name | HAMIL J WILLOUGHBY DDS
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Gender | Male
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 184 SULLIVAN HALL STONY BROOK UNIVERSITY SCHOOL OF DENTAL MEDICINE
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City | STONY BROOK
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State | NY
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Zip | 11794-8705
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Country | US
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Telephone | 631-632-8975
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Fax | 631-632-3747
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Provider Business Mailing Address
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Address Line | 59 MEREDITH AVE
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City | SAG HARBOR
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State | NY
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Zip | 11963-3224
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Country | US
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Telephone | 631-725-8798
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Fax |
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 027222
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License Number State | NY
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