Organization Name: | HANK WILLIS, DDS, PLLC |
NPI Number: | 1215196209 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HANK WILLI (DENTIST) |
Mailing Address: | 6811 Main St Ste A Bonners Ferry |
State: | ID US |
Postal Code: | 838058649 |
Phone Number: | 2082676454 |
Fax Number: | 2082676457 |
NPI Enumeration Date: | 06/04/2008 |
NPI Last Update Date: | 06/04/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |