Active NPI
Nancy Willis, D.D.S.
- Pediatric Dentistry
- Scranton, PA
National Provider Identifier
1104982206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DS 027099-L
- Practice address
- 387 N 9TH Ave
Scranton, PA 18504-2005 - Phone
- (570) 343-8885
- NPI assigned
- Dec 31, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DS 027099-L | PA | Primary |
Addresses
Primary practice location
387 N 9TH Ave
Scranton, PA 18504-2005
Mailing address
387 N 9TH Ave
Scranton, PA 18504-2005
Phone (570) 343-8885
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DS 027099-L | Other | PA | PA STATE DENTAL LICENSE |
| 0012201610001 | Medicaid | PA | |
| 669980 | Other | PA | UNITED CONCORDIA |
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 |
|---|---|---|---|
| DS 027099-L | PA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583107200000",
"number": "1104982206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "387 N 9TH AVE",
"city": "SCRANTON",
"state": "PA",
"postal_code": "185042005",
"telephone_number": "570-343-8885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "387 N 9TH AVE",
"city": "SCRANTON",
"state": "PA",
"postal_code": "185042005",
"telephone_number": "570-343-8885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "NANCY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-31",
"last_updated": "2020-03-02",
"certification_date": "2020-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "PA",
"license": "DS 027099-L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA STATE DENTAL LICENSE",
"identifier": "DS 027099-L",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0012201610001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "669980",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Scranton, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.