Provider Demographics
NPI:1902003312
Name:WILLIS, ALLENA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLENA
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:ALLENA
Other - Middle Name:WILLIS
Other - Last Name:KENNERLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2021 K STREET NW
Mailing Address - Street 2:#301
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006
Mailing Address - Country:US
Mailing Address - Phone:202-379-5103
Mailing Address - Fax:972-992-9865
Practice Address - Street 1:2021 K ST NW
Practice Address - Street 2:#301
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1003
Practice Address - Country:US
Practice Address - Phone:202-379-5103
Practice Address - Fax:972-992-9865
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10004841223X0400X
MD138611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics