Kenneth Daniel Willis, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

30.025895 Issued in OH

Practice address

878 Jackson Pike
Gallipolis, OH 45631-1391

Phone

(740) 446-7806

NPI assigned

May 11, 2018

Last updated

Aug 25, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• DRS. Frankel & Puhl LLC

  • Dentist
  • Maumee, OH
  • NPI 1548594310
  NPD (past)
• Jon Frankel Dentistry Inc.

  • Dentist
  • Toledo, OH
  • NPI 1528472065
  NPD (past)
• Kyger Dental Associates Inc

  • Dentist
  • Gallipolis, OH
  • NPI 1063959864
  NPD (past)

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

{
    "created_epoch": "1525996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661385600000",
    "number": "1457841835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "878 JACKSON PIKE",
            "city": "GALLIPOLIS",
            "state": "OH",
            "postal_code": "456311391",
            "telephone_number": "740-446-7806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "878 JACKSON PIKE",
            "city": "GALLIPOLIS",
            "state": "OH",
            "postal_code": "456311391",
            "telephone_number": "740-446-7806"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5012 Talmadge Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "43623",
            "country_code": "US",
            "telephone_number": "419-474-9611",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4359 Keystone Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Maumee",
            "state": "OH",
            "postal_code": "435378709",
            "country_code": "US",
            "telephone_number": "419-893-0221",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3000 Arlington Ave",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436142598",
            "country_code": "US",
            "telephone_number": "419-383-3805",
            "fax_number": "419-383-2969",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "KENNETH",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-11",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.025895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marlena Ashley Williams
• Miles T Williams, LPC
• Sherri L Williams, NP
• Ashley Willis, LSW
• Betty J Willis, LSW
• Shelbie Lynn Willis, RN
• Susan R Willis, LPC
• Tonya R Winfield
• Bethany E Wolfe, F.N.P.
• Karen Diana Wong, DO

• Dentist in Gallipolis, OH
• Providers in Gallipolis, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; 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.