Provider Demographics
NPI:1164855482
Name:WILLIS, KALI (DDS)
Entity Type:Individual
Prefix:DR
First Name:KALI
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S CESAR CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78839-4200
Mailing Address - Country:US
Mailing Address - Phone:830-374-2301
Mailing Address - Fax:
Practice Address - Street 1:308 S CESAR CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78839-4200
Practice Address - Country:US
Practice Address - Phone:830-374-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-11
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX289651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice