Willis, Mark A
Willis, Mark A is an individual health care provider with primary practice located at 1795 Resurgence Dr , Watkinsville GA 30677-7306. He recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as his primary health care specialty. Willis, Mark A can be contacted via phone (479) 692-1392.Contact Information
Primary practice address
1795 Resurgence Dr
Watkinsville GA 30677-7306
Phone: (479) 692-1392
Fax: (770) 982-0005
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Pediatric Dentistry | 1223P0221X | 2634 | Arkansas |
| Dental Providers / Pediatric Dentistry | 1223P0221X | DN015576 | Georgia |
Profile Details
| NPI number | 1326136326 |
|---|---|
| LBN Legal business name | Willis, Mark A |
| Credentials | D.D.S., M.S., P.A. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 11th, 2006 |
| Last updated | Jun 17th, 2024 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1326136326 | NPPES |
| Oklahoma | MEDICAID | 100140260A |
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