Provider Demographics
NPI:1336119668
Name:WILLOUGHBY, DAVID L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:WILLOUGHBY
Suffix:
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 1:6111 TAYLOR RANCH DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2640
Mailing Address - Country:US
Mailing Address - Phone:505-898-2000
Mailing Address - Fax:505-898-0888
Practice Address - Street 1:6111 TAYLOR RANCH DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2640
Practice Address - Country:US
Practice Address - Phone:505-898-2000
Practice Address - Fax:505-898-0888
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM14371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice