Ralph Glen Willis, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3242 Issued in SC

Practice address

1144-F India Hook Rd
Rock Hill, SC 29732

Phone

(803) 327-4166

Fax

(803) 327-2086

NPI assigned

Oct 13, 2006

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 SC

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 and National Provider Directory roles.

• R. Glen Willis, DMD, PA

  • General Practice Dentistry
  • Rock Hill, SC
  • NPI 1063581270
  NPD (past) Authorized official

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317686400000",
    "number": "1700976727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1144-F INDIA HOOK RD",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "29732",
            "telephone_number": "803-327-4166",
            "fax_number": "803-327-2086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1144-F INDIA HOOK RD",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "29732",
            "telephone_number": "803-327-4166",
            "fax_number": "803-327-2086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "RALPH",
        "middle_name": "GLEN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2011-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "3242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tina Cecelia Williams
• Tracey Nicole Williams, CRNA
• Tracy Williams
• Victoria Williams, RBT
• Madeline Williamson
• Samantha Kaye Willis
• Sheena Willis
• Tyler Grant Willson
• Ebony Wilmore
• Alyssa Wilson, RBT

• General Practice Dentistry in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; 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.