NPI age
19 years
Enumerated 2006-10-11
● Active
Type 1 · Individual
DR. Mark A Willis, D.D.S., M.S., P.A.
Willis is 1 of 7 dentist providers in Watkinsville and 1 of 539 in Georgia.
Primary specialty
Dentist
Plus 1 subspecialty
Licensed in
GA, AR
2 states
Status
Active
No deactivations on record
Last NPPES update
2024-06-17
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 539 active dentist providers in Georgia.
NPI age
19 years
↑ 3 yr above median (16 yr)
State licenses
2 states
Top 88% — 11% of peers are multi-state
Subspecialties
0
26% of peers hold subspecialties
NPI lifetime · 2006 → 2026
2006-10Enumerated in NPPES
2006
2026
Where they practice
Practice location
1795 Resurgence Dr
Watkinsville, GA 306777306
Mailing address
1390 Natchez Way
Grayson, GA 300171084
Specialties
-
Dentist PrimaryAn age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (OK) | 100140260A |
Multi-state credentialing: Licensed in 2 states. Useful context for credentialers building cross-state provider networks.
Practice context
Solo or small practice. No other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
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