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General NPI Number Information
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NPI Number | 1598859746
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Entity Type | Individual
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Provider Name | DEAN NORMAN WILLIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 50 FAIR HARBOUR PL SUITE 2-C
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City | NEW LONDON
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State | CT
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Zip | 06320-4731
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Country | US
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Telephone | 860-443-3147
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Fax | 860-443-0087
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Provider Business Mailing Address
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Address Line | 50 FAIR HARBOUR PL SUITE 2-C
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City | NEW LONDON
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State | CT
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Zip | 06320-4731
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Country | US
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Telephone | 860-443-3147
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Fax | 860-443-0087
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 22374
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License Number State | CT
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