Provider Demographics
NPI:1144508128
Name:HEATHER A WILLIS DDS LLC
Entity type:Organization
Organization Name:HEATHER A WILLIS DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-687-3491
Mailing Address - Street 1:4001 GEIST RD
Mailing Address - Street 2:STE 5B
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3552
Mailing Address - Country:US
Mailing Address - Phone:907-479-3326
Mailing Address - Fax:
Practice Address - Street 1:4001 GEIST RD
Practice Address - Street 2:STE 5B
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3552
Practice Address - Country:US
Practice Address - Phone:907-479-3326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty