Provider Demographics
NPI:1336298926
Name:J. DEWEY WILLIS III, D.D.S., P.C., & ASSOC.
Entity type:Organization
Organization Name:J. DEWEY WILLIS III, D.D.S., P.C., & ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:DEWEY
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-873-3407
Mailing Address - Street 1:11828 FISHING POINT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4500
Mailing Address - Country:US
Mailing Address - Phone:757-873-3407
Mailing Address - Fax:
Practice Address - Street 1:11828 FISHING POINT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4500
Practice Address - Country:US
Practice Address - Phone:757-873-3407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty