Provider Demographics
NPI:1821398298
Name:WILLIS, SCHRIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCHRIE
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5335 BROADWAY BLVD
Mailing Address - Street 2:STE 209
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-7000
Mailing Address - Country:US
Mailing Address - Phone:972-240-7585
Mailing Address - Fax:
Practice Address - Street 1:5335 BROADWAY BLVD
Practice Address - Street 2:STE 209
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-7000
Practice Address - Country:US
Practice Address - Phone:972-240-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241911223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice