Provider Demographics
NPI:1821147562
Name:J DEWEY WILLIS III, D.D.S., P.C. & ASSOC
Entity Type:Organization
Organization Name:J DEWEY WILLIS III, D.D.S., P.C. & ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:DEWEY
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-873-3407
Mailing Address - Street 1:801 GREENBRIER PKWY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3822
Mailing Address - Country:US
Mailing Address - Phone:757-547-3003
Mailing Address - Fax:
Practice Address - Street 1:801 GREENBRIER PKWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3822
Practice Address - Country:US
Practice Address - Phone:757-547-3003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty