Provider Demographics
NPI:1992895148
Name:WILLIS, J. DEWEY III (DDS)
Entity type:Individual
Prefix:DR
First Name:J.
Middle Name:DEWEY
Last Name:WILLIS
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 GREENBRIER PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3822
Mailing Address - Country:US
Mailing Address - Phone:757-873-3407
Mailing Address - Fax:757-436-0252
Practice Address - Street 1:801 GREENBRIER PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3822
Practice Address - Country:US
Practice Address - Phone:757-873-3407
Practice Address - Fax:757-436-0252
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401-0050831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice