Individual provider Active NPI

Barry Wills, D.M.D.

  • General Practice Dentistry
  • Philadelphia, PA
National Provider Identifier
1649384728
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS016301L Issued in PA
Practice address
10752 Bustleton Ave
Philadelphia, PA 19116-3367
Phone
(215) 677-3030
Fax
(215) 671-0148
NPI assigned
Aug 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS016301L PA Primary

Addresses

Primary practice location

10752 Bustleton Ave
Philadelphia, PA 19116-3367

Mailing address

10752 Bustleton Ave
Philadelphia, PA 19116-3367
Phone (215) 677-3030

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20160201000095 PA Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 6608170394

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649384728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10752 BUSTLETON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191163367",
            "telephone_number": "215-677-3030",
            "fax_number": "215-671-0148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10752 BUSTLETON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191163367",
            "telephone_number": "215-677-3030",
            "fax_number": "215-671-0148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLS",
        "first_name": "BARRY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS016301L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.