Alec Douglas Willard, DDS
Individual provider Active NPI Dentist · Gas City, IN
NPI 1639738867 · NPPES record last updated Jul 9, 2019
Key facts
- NPI
- 1639738867
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 12013191A (IN)
- Practice address
- 717 E Main St
Gas City, IN 46933-1545 - Phone
- (765) 674-7241
- NPI assigned
- Jun 11, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12013191A | IN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dentura LLC | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12013191A | IN | Yes |
Addresses
Primary practice location
717 E Main St
Gas City, IN 46933-1545
Mailing address
717 E Main St
Gas City, IN 46933-1545
Phone (765) 674-7241
Other providers in Gas City, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.