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General NPI Number Information
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NPI Number | 1841265204
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Entity Type | Individual
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Provider Name | BRIAN WILLETTS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1321 MOUNT CARMEL RD
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City | PARKTON
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State | MD
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Zip | 21120-9763
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Country | US
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Telephone | 410-357-5151
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Fax | 410-357-0880
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Provider Business Mailing Address
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Address Line | 14213 QUAIL CREEK WAY #312
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City | SPARKS
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State | MD
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Zip | 21152-8877
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Country | US
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Telephone | 410-472-4587
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Fax | 410-357-0880
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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 | 7867
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License Number State | MD
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