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General NPI Number Information
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NPI Number | 1558230110
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Entity Type | Organization
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Legal Business Name | WILLIS ORAL HEALTH SERVICES, L.L.C.
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 5821 WOODLAND DR
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City | OXON HILL
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State | MD
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Zip | 20745-1234
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Country | US
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Telephone | 301-830-8146
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Fax |
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Provider Business Mailing Address
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Address Line | 5821 WOODLAND DR
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City | OXON HILL
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State | MD
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Zip | 20745-1234
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Country | US
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Telephone | 301-830-8146
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Fax |
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Authorized Official
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Title or Position | DENTAL HYGENIST
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Name | MRS. NICCETA WILLIS
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Credential |
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Telephone | 615-545-1471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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