Active NPI
Brian Jeremy Wills, DDS
- General Practice Dentistry
- Petoskey, MI
National Provider Identifier
1225139348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2901010974
- Practice address
- 204 State St
Petoskey, MI 49770-2718 - Phone
- (231) 347-8980
- NPI assigned
- Sep 25, 2006
- 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 | 2901010974 | MI | Primary |
Addresses
Primary practice location
204 State St
Petoskey, MI 49770-2718
Mailing address
204 State St
Petoskey, MI 49770-2718
Phone (231) 347-8980
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4037439 | Medicaid | MI |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1225139348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 STATE ST",
"city": "PETOSKEY",
"state": "MI",
"postal_code": "497702718",
"telephone_number": "231-347-8980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 STATE ST",
"city": "PETOSKEY",
"state": "MI",
"postal_code": "497702718",
"telephone_number": "231-347-8980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLS",
"first_name": "BRIAN",
"middle_name": "JEREMY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "2901010974",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4037439",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Petoskey, MI
- Timothy R Wilcox, MD
- Karolyn Angela Wilder, RN, PMHNP
- Megan Willemstein, PHARMD
- Harold James Willens, MD
- William J. Steinbach D.C.,P.C.
- Wilson Wellness Counseling, Coaching & Consulting LLC
- Matthew Royal Wilson, CRNA
- Rose Marie Wilson, LMSW, CAADC, CCS-D
- William Thomas Wilson, MSW, ACSW
- Vincent Jan Winklerprins, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.