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NPI Code Detail

MEDICARE: DR. GILES WILLIS JR. DDS

MEDICARE: DR. GILES WILLIS JR. DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist8047NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043396948
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GILES WILLIS JR. DDS
Provider Business Mailing Address
First Line : 200 IRON HILL DR
Second Line :
City : CARY
State : NC
Zip : 27519-6931
Country : US
Telephone Number : 919-372-9548
Fax Number :
Provider Business Practice Location Address
First Line : 7228 PITTSBORO-MONCURE ROAD
Second Line :
City : MONCURE
State : NC
Zip : 27559-0980
Country : US
Telephone Number : 919-543-1641
Fax Number : 919-542-3726
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2006
Last Update Date : 07/08/2007

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