Provider Demographics
NPI:1457440679
Name:WILLOW, GAIL ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:ANN
Last Name:WILLOW
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 1:507 N BULLARD ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-5408
Mailing Address - Country:US
Mailing Address - Phone:505-388-2541
Mailing Address - Fax:
Practice Address - Street 1:507 N BULLARD ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5408
Practice Address - Country:US
Practice Address - Phone:505-388-2541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD1535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist