Active NPI
Theodore Albert McWillie, D.D.S.
- General Practice Dentistry
- Las Vegas, NV
National Provider Identifier
1083800429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2103
- Practice address
- 4660 S Eastern Ave
Suite 103
Las Vegas, NV 89119-6137 - Phone
- (702) 456-0005
- NPI assigned
- Sep 19, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2103 | NV | Primary |
Addresses
Primary practice location
4660 S Eastern Ave
Suite 103
Las Vegas, NV 89119-6137
Mailing address
4660 S Eastern Ave
Suite 103
Las Vegas, NV 89119-6137
Phone (702) 456-0005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2103 | NV | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190160000000",
"number": "1083800429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4660 S EASTERN AVE",
"address_2": "SUITE 103",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891196137",
"telephone_number": "702-456-0005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4660 S EASTERN AVE",
"address_2": "SUITE 103",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891196137",
"telephone_number": "702-456-0005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCWILLIE",
"first_name": "THEODORE",
"middle_name": "ALBERT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-19",
"last_updated": "2007-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NV",
"license": "2103",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.