Provider Demographics
NPI:1699733717
Name:WILLIFORD, MARILEE REYNOLDS (DDS)
Entity type:Individual
Prefix:DR
First Name:MARILEE
Middle Name:REYNOLDS
Last Name:WILLIFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801B WOOTEN BLVD SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-8625
Mailing Address - Country:US
Mailing Address - Phone:252-237-8812
Mailing Address - Fax:252-243-9036
Practice Address - Street 1:2801B WOOTEN BLVD SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8625
Practice Address - Country:US
Practice Address - Phone:252-237-8812
Practice Address - Fax:252-243-9036
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990085Medicaid
NC02465Medicare UPIN