Active NPI
Robert A Willis, DMD
- Dentist
- Clemmons, NC
National Provider Identifier
1265020770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12109
- Practice address
- 177 Waddington Rd
Clemmons, NC 27012-9066 - Phone
- (919) 917-8250
- NPI assigned
- Jan 10, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12109 | NC | |
| Dentist | 122300000X | 12109 | NC | Primary |
Addresses
Primary practice location
177 Waddington Rd
Clemmons, NC 27012-9066
Mailing address
177 Waddington Rd
Clemmons, NC 27012-9066
Phone (919) 917-8250
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 |
|---|---|---|---|
| 12109 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716163200000",
"number": "1265020770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "177 WADDINGTON RD",
"city": "CLEMMONS",
"state": "NC",
"postal_code": "270129066",
"telephone_number": "919-917-8250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "177 WADDINGTON RD",
"city": "CLEMMONS",
"state": "NC",
"postal_code": "270129066",
"telephone_number": "919-917-8250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "ROBERT",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-10",
"last_updated": "2024-05-20",
"certification_date": "2024-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "12109",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "12109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clemmons, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.