JACLYN JENNIFER WILLIS (NPI# 1700498631) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700498631 |
| Entity Type | Individual |
| Full Name | JACLYN JENNIFER WILLIS |
| Credential | DDS |
| Practice Address |
Ardennes Street Fort Bragg NC 28307 |
| Mailing Address |
1336 Bozeman Loop Apt 61 Fayetteville NC 28303-5692 |
| Practice Telephone | 9104328170 |
| Mailing Telephone | 9103816578 |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2020-08-21 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 25132 | FL | Dental Providers |
| Street Address |
ARDENNES STREET |
| City | FORT BRAGG |
| State | NC |
| Zip Code | 28307 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003398850 | Bailey Moorhead | Dentist | Bldg C-6238 Ardennes Road, Fort Bragg, NC 28307 | 2018-08-29 |
| 1619454980 | Seth David Williams | Physician Assistant | Bldg C-1722 Tagatay Dr, Fort Bragg, NC 28307 | 2018-07-19 |
| 1134633894 | Ashley Andrick | Physician Assistant | 1722 Tagatay Dr, Fort Bragg, NC 28307 | 2017-11-16 |
| 1184144479 | Thomas William Hanna IIi | Dentist | Bldg C-6238 Ardennes St., Fort Bragg, NC 28307 | 2017-06-27 |
| 1720530355 | Robert Holly | Military Health Care Provider | 7606 Reilly Rd, Bldg 2, Fort Bragg, NC 28307 | 2016-10-31 |
| 1891246708 | Womack Army Medical Center | Pharmacy | 1571 Reilly Rd, Bldg 4, Ft Bragg, NC 28307 | 2016-10-17 |
| 1710319405 | Valerie D. Jefferys | Pharmacist | 2817 Reily Road Womack Army Medical Center, Apo, AE 28307 | 2013-08-05 |
| 1689976367 | Komkwuan Pholtavee Paruchabutr | Registered Nurse | Building 4-2817 Reilly Road, Fort Bragg, NC 28307 | 2010-12-01 |
| 1609032879 | Kristi Lyn Natalino | Physical Therapist | 2817 Reilly Rd Bldg 4, Physical Therapy Department, Fort Bragg, NC 28307 | 2008-08-06 |
| 1841465051 | Mary Thomas Plunkett | Internal Medicine | Building 4-2817 Reilly Road Womack Army Medical Center, Internal Medicine Dept - Fort Bragg, Fayetteville, NC 28307 | 2008-04-29 |
| Find all providers in zip 28307 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487265039 | John Michael Mckelvey Jr. | Dentist | 6238 Ardennes St, Fort Bragg, NC 28310-0001 | 2020-08-16 |
| 1447805254 | Ross Carroll | Dentist | 1700 Goldberg St, Fort Bragg, NC 28310-0001 | 2019-08-08 |
| 1003398850 | Bailey Moorhead | Dentist | Bldg C-6238 Ardennes Road, Fort Bragg, NC 28307 | 2018-08-29 |
| 1679054217 | Christopher Cetnar | Dentist | Smokebomb Hill, Bldg 3718 Gruber Road, Fort Bragg, NC 28310 | 2018-08-22 |
| 1316427107 | Alexandrea Lee Clark | Dentist | Laflamme Dental Clinic, Bldg C6238 Ardennes Road, Fort Bragg, NC 28310 | 2018-08-21 |
| 1528546322 | Michael J Rethman | Dentist | Bldg M4861 Logistics Avenue Joel Dental Clinic, Fort Bragg, NC 28310-7302 | 2018-08-02 |
| 1245749324 | Michael Stewart Almony | Dentist | Bldg C-6238 Ardennes St, Fort Bragg, NC 28310-0001 | 2017-09-21 |
| 1609392034 | Elliot James Devinney | Dentist | Usa Dental Activity, Attn: Mcds Na B, Bldg 6837 Normandy Drive, Fort Bragg, NC 28310-7302 | 2017-08-17 |
| 1093231425 | Walter Garwood Hinman V | Dentist | Bldg 6837 Normandy Drive Attn: Mcds Na B, Fort Bragg, NC 28310-0001 | 2017-08-17 |
| 1689199267 | Mckinnon Forbes | Dentist | Bldg H-4861 Logistic Ave, Fort Bragg, NC 28310-0001 | 2017-08-04 |
| Find all providers in FORT BRAGG | ||||
| City | FORT BRAGG |
| Zip Code | 28307 |
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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.