Provider Demographics
NPI:1245336593
Name:WILLIS, CLAUDE E (DDS)
Entity type:Individual
Prefix:
First Name:CLAUDE
Middle Name:E
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 1:5938 W STATE ROAD 135
Mailing Address - Street 2:
Mailing Address - City:TRAFALGAR
Mailing Address - State:IN
Mailing Address - Zip Code:46181-8881
Mailing Address - Country:US
Mailing Address - Phone:812-597-5857
Mailing Address - Fax:812-597-5847
Practice Address - Street 1:5938 W STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:TRAFALGAR
Practice Address - State:IN
Practice Address - Zip Code:46181-8881
Practice Address - Country:US
Practice Address - Phone:812-597-5857
Practice Address - Fax:812-597-5847
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006990A&B1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice