Jack Edward Willoughby, D.D.S. Valid NPI
Individual provider · General Practice Dentistry · Edmond, OK
- NPI
- 1487666467
- Type
- Individual (Type 1)
- Primary specialty
- General Practice Dentistry (Dentist)
- Specialty group
- Dental Providers
- Taxonomy code
- 1223G0001X
- License number
- 4150 (OK)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2006-08-11
- Last updated
- 2007-07-08
Practice location
1222 S Kelly Ave
Edmond, OK 73003-5855
(405) 341-8518