Provider Demographics
NPI:1295889434
Name:WILLIS, DEBRA A (DMD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:A
Last Name:WILLIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 LILLY LN
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-9180
Mailing Address - Country:US
Mailing Address - Phone:509-630-6492
Mailing Address - Fax:
Practice Address - Street 1:237 LILLY LN
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-9180
Practice Address - Country:US
Practice Address - Phone:509-630-6492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000071751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5042650Medicaid
WA5399209Medicaid