DR. JOHN ELLIOTT WILLARDSEN (NPI# 1194745364) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194745364 |
| Entity Type | Individual |
| Full Name | DR. JOHN ELLIOTT WILLARDSEN |
| Credential | DDS |
| Practice Address |
74-900 Hwy 111 Suite 110 Indian Wells CA 92110 |
| Mailing Address |
907 Sunset Hills Lane Redlands CA 92373 |
| Practice Telephone | 7607733437 |
| Mailing Telephone | 9092730770 |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
45339 | CA | Dental Providers |
| Street Address |
74-900 HWY 111 SUITE 110 |
| City | INDIAN WELLS |
| State | CA |
| Zip Code | 92110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801093844 | Frank Conyngham Crawford II | Dentist | 74-900 Hwy 111, Suite 210, Indian Wells, CA 92210 | 2007-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669021713 | Ruben Daniel Gutierrez | Marriage & Family Therapist | 4141 Pacific Coast Hwy, San Diego, CA 92110 | 2019-09-10 |
| 1548724081 | Denise Ellen Thompson | Counselor | 3255 Wings Street, San Diego, CA 92110 | 2019-01-29 |
| 1801378716 | Michelle Lisa Jean Crawford | Student in an Organized Health Care Education/Training Program | 3767 Central Avenue, San Diego, CA 92110 | 2018-09-06 |
| 1427539048 | Allison Turrell | Case Manager/Care Coordinator | 4930 Naples Street, San Diego, CA 92110 | 2018-08-22 |
| 1750872768 | Matthew Langworthy | Physical Therapist | 3405 Kenyon St Ste 212, San Diego, CA 92110 | 2018-05-24 |
| 1245748342 | The One Health Boutique, LLC | Chiropractor | 5350 Riley St, San Diego, CA 92110 | 2018-01-11 |
| 1437670155 | Monique A Fernandez | Counselor | 3132 Jefferson Street, San Diego, CA 92110 | 2017-07-03 |
| 1538510391 | Mayu Winters | Registered Nurse | 853 Rosecrans St, San Diego, CA 92110 | 2016-06-23 |
| 1376998864 | Briniti Ichull | Specialist | 3941 Kurtz St, San Diego, CA 92110 | 2016-05-03 |
| 1912352576 | Healthcare Services, Inc. | Substance Abuse Rehabilitation Facility | 3880 Rosecrans Street, San Diego, CA 92110 | 2016-05-02 |
| Find all providers in zip 92110 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992009963 | Woo Yong Lee | Dentist | 74900 Us Highway 111, Ste 110, Indian Wells, CA 92210-7100 | 2011-01-05 |
| 1124147442 | George Altuzarra | Dentist | 74965 Us Highway 111, Indian Wells, CA 92210-7136 | 2007-03-28 |
| 1669625588 | Mohammad Hishmeh | Dentist | 74965 Us Highway 111, Indian Wells, CA 92210-7136 | 2008-10-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255932141 | Jason T Garland | Dentist | 7892 Sitio Mirto, Carlsbad, CA 92009-6999 | 2020-11-05 |
| 1386245462 | Miller Skinner and Dastrup Dental Corporation of Madera | Dentist | 118 N A St, Madera, CA 93638-3210 | 2020-11-04 |
| 1912508177 | Adrian Acosta Dds A Professional Dental Corp | Dentist | 951 W. Whittier Blvd, La Habra, CA 90631-3743 | 2020-11-04 |
| 1871194175 | Lawrence G. Low Dds & Kenneth Y.k. Li Dds | Dentist | 229 Cajon St Ste 3, Redlands, CA 92373-5284 | 2020-11-03 |
| 1881295384 | Jimmy Nguyen Dds Inc | Dentist | 13089 Peyton Dr. Ste. B, Chino Hills, CA 91709 | 2020-11-03 |
| 1083214282 | Sara Davidson, Dds, PC | Dentist | 176 Terra Vista Ave, San Francisco, CA 94115-3824 | 2020-10-27 |
| 1871192484 | David Moody Dental Corporation | Dentist | 19737 W Valley Blvd, Tehachapi, CA 93561-8601 | 2020-10-23 |
| 1407455181 | Julia Nguyen | Dentist | 9225 Mira Mesa Blvd Ste 218, San Diego, CA 92126-4811 | 2020-10-22 |
| 1104425248 | Aditi Mehndiratta | Dentist | 17585 Vierra Canyon Rd, Prunedale, CA 93907-3312 | 2020-10-20 |
| 1346849452 | Lauren Gabrielle Alfonso Santos | Dentist | 4005 Manzanita Ave Ste 50, Carmichael, CA 95608-1784 | 2020-10-20 |
| Find all providers with the same taxonomy | ||||
| City | INDIAN WELLS |
| Zip Code | 92110 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.