Provider Demographics
NPI:1649384728
Name:WILLS, BARRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:WILLS
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 1:10752 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3367
Mailing Address - Country:US
Mailing Address - Phone:215-677-3030
Mailing Address - Fax:215-671-0148
Practice Address - Street 1:10752 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3367
Practice Address - Country:US
Practice Address - Phone:215-677-3030
Practice Address - Fax:215-671-0148
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016301L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice