Active NPI
John R Willoughby, DDS, PHD
- General Practice Dentistry
- Yorktown, VA
National Provider Identifier
1245487453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 0401412434
- Practice address
- 4326 George Washington Highway
Yorktown, VA 23692-2707 - Phone
- (540) 867-0174
- NPI assigned
- Aug 20, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 049-23517 | OH | |
| General Practice Dentistry | 1223G0001X | 0401412434 | VA | Primary |
Addresses
Primary practice location
4326 George Washington Highway
Yorktown, VA 23692-2707
Mailing address
4326 George Washington Highway
Yorktown, VA 23692-2707
Phone (540) 867-0174
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0401412434 | Other | VA | DENTAL LICENSE # --- VIRGINIA |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 049-23517 | OH | MD | General Practice Dentistry |
| 0401412434 | VA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263254400000",
"number": "1245487453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4326 GEORGE WASHINGTON HIGHWAY",
"city": "YORKTOWN",
"state": "VA",
"postal_code": "236922707",
"telephone_number": "540-867-0174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4326 GEORGE WASHINGTON HIGHWAY",
"city": "YORKTOWN",
"state": "VA",
"postal_code": "236922707",
"telephone_number": "540-867-0174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLOUGHBY",
"first_name": "JOHN",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DDS, PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-20",
"last_updated": "2010-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OH",
"license": "049-23517",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "VA",
"license": "0401412434",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE # --- VIRGINIA",
"identifier": "0401412434",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yorktown, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.