Active NPI
Timothy Gay Willis, DDS
- Dentist
- Yreka, CA
National Provider Identifier
1225161680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 29525
- Practice address
- 310 Evergreen LN
Yreka, CA 96097-3203 - Phone
- (530) 842-5332
- Fax
- (530) 842-9029
- NPI assigned
- Mar 14, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 29525 | CA | Primary |
Addresses
Primary practice location
310 Evergreen LN
Yreka, CA 96097-3203
Mailing address
310 Evergreen LN
Yreka, CA 96097-3203
Phone (530) 842-5332
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 |
|---|---|---|---|
| 29525 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225161680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 EVERGREEN LN",
"city": "YREKA",
"state": "CA",
"postal_code": "960973203",
"telephone_number": "530-842-5332",
"fax_number": "530-842-9029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 EVERGREEN LN",
"city": "YREKA",
"state": "CA",
"postal_code": "960973203",
"telephone_number": "530-842-5332",
"fax_number": "530-842-9029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "TIMOTHY",
"middle_name": "GAY",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "29525",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yreka, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.