Active NPI
Robert L Willey, D.D.S.
- Endodontics
- Mammoth Lakes, CA
National Provider Identifier
1457433427
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 032414
- Practice address
- 71 Ridgecrest Dr
Mammoth Lakes, CA 93546-0101 - Phone
- (760) 920-0542
- Fax
- (760) 111-1111
- NPI assigned
- Oct 19, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 032414 | CA | Primary |
Addresses
Primary practice location
71 Ridgecrest Dr
Mammoth Lakes, CA 93546-0101
Mailing address
PO Box 101
PO Box 101
Mammoth Lakes, CA 93546-0101
Phone (760) 992-0054
Other names 1
- None None None
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 |
|---|---|---|---|
| 032414 | CA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220400000000",
"number": "1457433427",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 101",
"address_2": "PO BOX 101",
"city": "MAMMOTH LAKES",
"state": "CA",
"postal_code": "935460101",
"telephone_number": "760-992-0054",
"fax_number": "760-111-1111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "71 RIDGECREST DR",
"city": "MAMMOTH LAKES",
"state": "CA",
"postal_code": "935460101",
"telephone_number": "760-920-0542",
"fax_number": "760-111-1111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLEY",
"first_name": "ROBERT",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2008-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "032414",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "NONE",
"last_name": "NONE",
"middle_name": "NONE",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Mammoth Lakes, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 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.