Warren Willis DMD P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-3635 Issued in ID

Legal business name

WARREN WILLIS DMD P.C.

Practice address

119 N Wardwell Ave
Emmett, ID 83617-3040

Phone

(208) 365-6313

NPI assigned

Dec 17, 2008

Organization subpart

No

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

Authorized official

Name

Warren Richard Willis, DMD

Title

Owner

Phone

(208) 365-6313

Specialties & licenses 1

Addresses

Other names 1

• Emmett Dental Group P.C. Doing business as

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

{
    "created_epoch": "1229472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229472000000",
    "number": "1255577490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 N WARDWELL AVE",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836173040",
            "telephone_number": "208-365-6313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 N WARDWELL AVE",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836173040",
            "telephone_number": "208-365-6313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WARREN WILLIS DMD P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-17",
        "last_updated": "2008-12-17",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "WARREN",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-365-6313",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emmett Dental Group P.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Walter Knox Memorial Hospital
• Walter Knox Memorial Hospital
• Walter Knox Memorial Hospital
• Trenton G. Warner, O.D.
• Emme Warnken
• Laura Ann Watson, LCSW
• Lisa Watson, LMSW, LCSW
• Ty C Weber, FNP-C
• Shane Weideman
• Evan White

• General Practice Dentistry in Emmett, ID
• Providers in Emmett, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.