Henry SK Willis IV, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-3784 Issued in ID

Practice address

6811 Main St
Suite a
Bonners Ferry, ID 83805-8649

Phone

(208) 267-6454

NPI assigned

Oct 31, 2005

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 ID

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

Practice roles

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

• Hank Willis, DDS, PLLC

  • Dental Clinic/Center
  • Bonners Ferry, ID
  • NPI 1215196209
  NPD (past)

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184198400000",
    "number": "1578554465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6811 MAIN ST",
            "address_2": "SUITE A",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838058649",
            "telephone_number": "208-267-6454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6811 MAIN ST",
            "address_2": "SUITE A",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838058649",
            "telephone_number": "208-267-6454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "HENRY",
        "middle_name": "SK",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2007-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madicyn Weddington
• Kathryn L Wenzel, LCSW
• Robert B. Wenzel, LCPC
• Wild Life Community Counseling PLLC
• Wildwood L.L.C
• John Willis
• Stuart Kendall Willis III, MD
• William Lamont Worden, MD
• Kelli L Wright, LCSW
• Robert Yost, MD

• General Practice Dentistry in Bonners Ferry, ID
• Providers in Bonners Ferry, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2007; 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.