David Willis DMD, LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

D7786 Issued in OR

Legal business name

DAVID WILLIS DMD, LLC

Practice address

1261 Lancaster Dr NE
Salem, OR 97301-1959

Phone

(503) 364-3004

Fax

(503) 364-1623

NPI assigned

Aug 10, 2016

Organization subpart

No

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

Authorized official

Name

Dr. David G Willis, D.M.D.NPI 1841395977

Title

Dentist

Phone

(503) 364-3004

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Willis Dental Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David G Willis, DMD

  • General Practice Dentistry
  • Salem, OR
  • NPI 1841395977
  NPD (past) Authorized official

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

{
    "created_epoch": "1470787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475193600000",
    "number": "1629522396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1261 LANCASTER DR NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973011959",
            "telephone_number": "503-364-3004",
            "fax_number": "503-364-1623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1261 LANCASTER DR NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973011959",
            "telephone_number": "503-364-3004",
            "fax_number": "503-364-1623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID WILLIS DMD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-10",
        "last_updated": "2016-09-30",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "503-364-3004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "OR",
            "license": "D7786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVID G. WILLIS, DMD",
            "identifier": "1841395977",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willis Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ryan W. Daven, MSW, CADC II, LCSW
• Cathy Ann Davenport, L.M.T.
• Katherine Mariah Davenport, PSY.D.
• David M Freed PHD PC
• David M. Ross, DMD
• Christopher Allen David
• Benton John Davidson, MD
• Carli Davidson
• Diane Davidson, L.M.T.
• Jocelyn Linao Davidson, LMT

• Customized Equipment (DME) in Salem, OR
• Providers in Salem, OR by specialty
• Customized Equipment (DME) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.