Provider Demographics
NPI:1477701142
Name:WILLIS, JAMES WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:WILLIS
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 1:2150 MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CAMBRIA
Mailing Address - State:CA
Mailing Address - Zip Code:93428-3022
Mailing Address - Country:US
Mailing Address - Phone:805-927-4811
Mailing Address - Fax:
Practice Address - Street 1:2150 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428-3022
Practice Address - Country:US
Practice Address - Phone:805-927-4811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist