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General NPI Number Information
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NPI Number | 1487981817
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Entity Type | Individual
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Provider Name | RYAN M WILLIS DDS
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Gender | Male
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Dates
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Enumeration Date | 11/05/2009
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Last Update Date | 11/05/2009
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Provider Practice Location Address
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Address Line | 1750 NORTH STONEBRIDGE DRIVE 105
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City | MCKINNEY
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State | TX
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Zip | 75071
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Country | US
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Telephone | 801-390-2361
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 N. STONEBRIDGE DRIVE SUITE #105
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City | MCKINNEY
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State | TX
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Zip | 75071
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Country | US
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Telephone | 801-390-2361
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25069
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License Number State | TX
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