Blake James Willoughby II, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN24534 Issued in FL

Practice address

3400 Burns Rd Ste 100
Palm Beach Gardens, FL 33410-4352

Phone

(561) 627-2122

NPI assigned

Apr 2, 2019

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Networks

• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Dental Care of Palm Beach Gardens

  • Dental Clinic/Center
  • Palm Beach Gardens, FL
  • NPI 1548821275
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1043772742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 HICKORY HILL RD",
            "city": "TEQUESTA",
            "state": "FL",
            "postal_code": "334692125",
            "telephone_number": "636-236-3177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 BURNS RD STE 100",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334104352",
            "telephone_number": "561-627-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLOUGHBY",
        "first_name": "BLAKE",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-02",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN24534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Williams, M.S. CCC-SLP
• Kenyetta Williams, BT
• Tahira Williams, DMD
• Tatyana Nicole Williams, DDS
• Toni Aaliyah Willie
• Ian Wilson, DC
• Michele Lee Wilson, LMHC, CAP
• Sophia Elizabeth Holden Wiltse, BA
• Katherine Elizabeth Wimmer
• Tara Marie Wingard, PA

• General Practice Dentistry in Palm Beach Gardens, FL
• Providers in Palm Beach Gardens, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.