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NPI Code Detail

MEDICARE: JOHN L WILLIS DDS

MEDICARE: JOHN L WILLIS 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
11223G0001XGeneral Practice Dentistry20295CA

General Provider Information

NPI Number : 1699942532
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN L WILLIS DDS
Provider Business Mailing Address
First Line : PO BOX AD
Second Line :
City : YUBA CITY
State : CA
Zip : 95992-1396
Country : US
Telephone Number : 530-751-3769
Fax Number : 530-751-1237
Provider Business Practice Location Address
First Line : 555 FREMONT ST
Second Line :
City : COLUSA
State : CA
Zip : 95932-2534
Country : US
Telephone Number : 530-458-5165
Fax Number : 530-458-7830
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2008
Last Update Date : 05/09/2008

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