Active NPI
Ronald Gordan Willis Jr., DMD
- Dentist
- Tallahassee, FL
National Provider Identifier
1013172808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN12812
- Practice address
- 2470 Care Dr
Tallahassee, FL 32308-4579 - Phone
- (850) 877-5151
- NPI assigned
- Jul 22, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN12812 | FL | Primary |
Addresses
Primary practice location
2470 Care Dr
Tallahassee, FL 32308-4579
Mailing address
2470 Care Dr
Tallahassee, FL 32308-4579
Phone (850) 877-5151
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 14, 2016 through Mar 14, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN12812 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216684800000",
"number": "1013172808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2470 CARE DR",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323084579",
"telephone_number": "850-877-5151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2470 CARE DR",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323084579",
"telephone_number": "850-877-5151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "RONALD",
"middle_name": "GORDAN",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-22",
"last_updated": "2008-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN12812",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tallahassee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.