Provider Demographics
NPI:1619137833
Name:WILLARD, JOSHUA C (DMD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:C
Last Name:WILLARD
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 1:3721 WOODMONT CT
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-2330
Mailing Address - Country:US
Mailing Address - Phone:817-437-6139
Mailing Address - Fax:
Practice Address - Street 1:5425 W SPRING CREEK PKWY
Practice Address - Street 2:162
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4236
Practice Address - Country:US
Practice Address - Phone:972-964-1855
Practice Address - Fax:972-943-9301
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12611223G0001X
TX278581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice