Provider Demographics
NPI:1043396948
Name:WILLIS, GILES JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GILES
Middle Name:
Last Name:WILLIS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 IRON HILL DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6931
Mailing Address - Country:US
Mailing Address - Phone:919-372-9548
Mailing Address - Fax:
Practice Address - Street 1:7228 PITTSBORO-MONCURE ROAD
Practice Address - Street 2:
Practice Address - City:MONCURE
Practice Address - State:NC
Practice Address - Zip Code:27559-0980
Practice Address - Country:US
Practice Address - Phone:919-543-1641
Practice Address - Fax:919-542-3726
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8047122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8999999Medicaid
NCE33985Medicare UPIN
NC8999999Medicaid