Jon Young Willingham, D.D.S.

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

100042 Issued in CA

Practice address

La Clinica Monument Dental 2000 Sierra Road
2ND Floor
Concord, CA 94518

Phone

(925) 363-1256

Fax

(925) 356-2499

NPI assigned

Aug 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522713600000",
    "number": "1306856356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 COLE AVE APT 1",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945964043",
            "telephone_number": "913-406-5142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "LA CLINICA MONUMENT DENTAL 2000 SIERRA ROAD",
            "address_2": "2ND FLOOR",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "94518",
            "telephone_number": "925-363-1256",
            "fax_number": "925-356-2499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12148 W 95th St",
            "address_purpose": "LOCATION",
            "city": "Lenexa",
            "state": "KS",
            "postal_code": "662153805",
            "country_code": "US",
            "telephone_number": "913-492-9660",
            "fax_number": "913-492-5899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLINGHAM",
        "first_name": "JON",
        "middle_name": "YOUNG",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2018-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "60319",
            "primary": false
        },
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "CA",
            "license": "100042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yvette Marie Williams
• Zachary Williams
• Destiny Aja Williamson
• Elizabeth Marie Williamson
• Mary Ann Williamson, NP
• Philicia Willingham
• Andrew John Willis
• Desiree Esperanza Willis
• Elijah Willis
• Jadzia Willis

• Public Health Dentistry in Concord, CA
• Providers in Concord, CA by specialty
• Public Health Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.