MEDICARE: DR. HEATHER ANN WILLIS D.D.S.

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
1	122300000X	Dentist	1252	AK

General Provider Information

NPI Number	:	1841475159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER ANN WILLIS D.D.S.

Provider Business Mailing Address
First Line	:	4001 GEIST RD STE 5
Second Line	:
City	:	FAIRBANKS
State	:	AK
Zip	:	99709-3569
Country	:	US
Telephone Number	:	907-479-3326
Fax Number	:	907-479-6410

Provider Business Practice Location Address
First Line	:	4001 GEIST RD STE 5
Second Line	:
City	:	FAIRBANKS
State	:	AK
Zip	:	99709-3569
Country	:	US
Telephone Number	:	907-479-3326
Fax Number	:	907-479-6410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	05/31/2023

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Directions to “ DR. HEATHER ANN WILLIS D.D.S.” Practice Location

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