Provider Demographics
NPI:1215196209
Name:HANK WILLIS, DDS, PLLC
Entity Type:Organization
Organization Name:HANK WILLIS, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HANK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLI
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-267-6454
Mailing Address - Street 1:6811 MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-8649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6811 MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-8649
Practice Address - Country:US
Practice Address - Phone:208-267-6454
Practice Address - Fax:208-267-6457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental