David O Willis, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4651 Issued in KY

Practice address

University of Louisville School of Dentistry
501 S. Preston St.
Louisville, KY 40292

Phone

(502) 852-5128

Fax

(502) 852-7163

NPI assigned

Oct 4, 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374537600000",
    "number": "1831285394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY",
            "address_2": "501 S. PRESTON ST.",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40292",
            "telephone_number": "502-852-5128",
            "fax_number": "502-852-7163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY",
            "address_2": "501 S. PRESTON ST.",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40292",
            "telephone_number": "502-852-5128",
            "fax_number": "502-852-7163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "DAVID",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2013-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "4651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willis Wellness LLC
• Alexis Willis
• Amy Brutscher Willis, CPNP-AC
• Beth Willis, LPCC
• Carrie Angela Willis, CRNA
• Hunter Willis, LPCC
• Jennifer R Willis, NP
• Mallorie Leigh Willis, APRN, CNM
• Michelle L Willis, CRTT
• Richard Troy Willis, D.C.

• General Practice Dentistry in Louisville, KY
• Providers in Louisville, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; 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.