Active NPI
James Walten Willis, D.D.S.
- Dentist
- Fishersville, VA
National Provider Identifier
1417187642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401412578
- Practice address
- 41 S Medical Park Dr
Fishersville, VA 22939-2333 - Phone
- (540) 885-4611
- NPI assigned
- Jul 22, 2009
- 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 | 0401412578 | VA | Primary |
Addresses
Primary practice location
41 S Medical Park Dr
Fishersville, VA 22939-2333
Mailing address
6948 Welbourne LN
Crozet, VA 22932-3346
Phone (304) 906-5300
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 |
|---|---|---|---|
| 0401412578 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667520000000",
"number": "1417187642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6948 WELBOURNE LN",
"city": "CROZET",
"state": "VA",
"postal_code": "229323346",
"telephone_number": "304-906-5300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41 S MEDICAL PARK DR",
"city": "FISHERSVILLE",
"state": "VA",
"postal_code": "229392333",
"telephone_number": "540-885-4611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "JAMES",
"middle_name": "WALTEN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-22",
"last_updated": "2022-11-04",
"certification_date": "2022-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401412578",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fishersville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.