Shaun Willis, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

27076 Issued in TX

Practice address

1108 N Mechanic St
El Campo, TX 77437

Phone

(979) 541-5400

NPI assigned

Jun 28, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Locations

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.

• Columbus Children'S Dentistry PLLC

  • Dentist
  • Columbus, TX
  • NPI 1265885057
  NPD Authorized official
• Willis 1 Dentistry PLLC

  • Dental Clinic/Center
  • El Campo, TX
  • NPI 1922553759
  NPD Authorized official
• Sleep Apnea Kerrville PLLC

  • Durable Medical Equipment & Medical Supplies
  • Kerrville, TX
  • NPI 1710414370
  NPD
• Saint Apollonia Medicaid Dental Clinic of Texas, PA

  • General Practice Dentistry
  • El Campo, TX
  • NPI 1447427422

  General Practice

  NPD (past)
• Saint Apolonia Medicaid Dental Clinic No 2 of Texas PA

  • General Practice Dentistry
  • Columbus, TX
  • NPI 1477871259

  General Practice

  NPD (past)

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

{
    "created_epoch": "1309219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539561600000",
    "number": "1942597976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 N MECHANIC ST",
            "city": "EL CAMPO",
            "state": "TX",
            "postal_code": "774373030",
            "telephone_number": "979-541-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 N MECHANIC ST",
            "city": "EL CAMPO",
            "state": "TX",
            "postal_code": "77437",
            "telephone_number": "979-541-5400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1426 Sidney Baker St",
            "address_purpose": "LOCATION",
            "city": "Kerrville",
            "state": "TX",
            "postal_code": "780282725",
            "country_code": "US",
            "telephone_number": "830-890-5225",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "106 Shult Dr Ste Ab",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "TX",
            "postal_code": "789343016",
            "country_code": "US",
            "telephone_number": "979-733-8844",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1108 N Mechanic St",
            "address_purpose": "LOCATION",
            "city": "El Campo",
            "state": "TX",
            "postal_code": "77437",
            "country_code": "US",
            "telephone_number": "979-541-5400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "SHAUN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-28",
        "last_updated": "2018-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "27076",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "27076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS DENTAL LICENSE",
            "identifier": "27076",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• West Wharton County Hospital District
• West Wharton County Hospital District
• West Wharton County Hospital District
• West Wharton County Hospital District
• Willis 1 Dentistry PLLC
• Gatha Neva Wilson, P.T.
• John Frederick Wissinger, MD
• Robin L. Yue, MD
• Clay Richard Zboril, PA-C
• Rebecca Aurora Zepeda, M. ED

• All providers in El Campo, TX
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2018; 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.