Provider Demographics
NPI:1164288684
Name:WILLIS-ORLANDO, ELLIOT R (DDS)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:R
Last Name:WILLIS-ORLANDO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ELLIOT
Other - Middle Name:R
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4201 RUCKER AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2215
Mailing Address - Country:US
Mailing Address - Phone:425-789-3789
Mailing Address - Fax:
Practice Address - Street 1:4201 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2215
Practice Address - Country:US
Practice Address - Phone:425-789-3789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-31831223G0001X
WADE616298851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice