Provider Demographics
NPI:1164288684
Name:WILLIS-ORLANDO, ELLIOT R (DDS)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:R
Last Name:WILLIS-ORLANDO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ELLIOT
Other - Middle Name:R
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6365
Mailing Address - Country:US
Mailing Address - Phone:206-543-0903
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-543-0903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program