Provider Demographics
NPI:1407060528
Name:WILLEY, DAVID E (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:WILLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4741 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-2064
Mailing Address - Country:US
Mailing Address - Phone:863-382-7676
Mailing Address - Fax:863-382-9940
Practice Address - Street 1:4741 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2064
Practice Address - Country:US
Practice Address - Phone:863-382-7676
Practice Address - Fax:863-382-9940
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00011175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist