Jeffrey Alan Willis, DDS, MS

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

1188483 Issued in NY

Practice address

2310 Craven St
San Diego, CA 92136-5596

Phone

(619) 556-9095

NPI assigned

Jul 8, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1594166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762214400000",
    "number": "1164040044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 CRAVEN ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921365596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 CRAVEN ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921365596",
            "telephone_number": "619-556-9095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JEFFREY",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-08",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "NY",
            "license": "1188483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeffrey.a.willis17.mil@health.mil",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "620 John Paul Jones Cir",
            "city": "Portsmouth",
            "state": "VA",
            "country_code": "US",
            "postal_code": "237082111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Davelyn Renee Willinger, RN
• Yasmine Dalya Willis Fernandez
• Amy Willis
• Ashlynn Kara Willis
• Elizabeth Willis
• Jessica Willis, MA
• Judith Willis
• Mary Jane Hall Willis, M.D.
• Molly Willis
• Robert Willis

• Prosthodontics in San Diego, CA
• Providers in San Diego, CA by specialty
• Prosthodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.