DALE WAYNE WILLOUGHBY DDS
NPI 1700880556
Dentist - Oral and Maxillofacial Surgery in Kenosha, WI

Q: What is Dale Willoughby's NPI number?

The NPI number for Dale Willoughby is 1700880556. It was assigned to this individual provider in the NPPES registry on June 9, 2005.

Q: What is Dale Willoughby's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Q: Is Dale Willoughby enrolled in Medicare?

No. Dale Willoughby has opted out of Medicare through March 19, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Q: When was this NPI record last updated?

The NPPES record for Dale Willoughby was last updated on June 2, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 09, 2005Opted out of Medicare · through Mar 19, 2028

6707 39TH AVE, KENOSHA, WI 53142(262) 658-3559(262) 658-0276 Get Directions Write a Review

NPPES record last updated: June 2, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Dale Wayne Willoughby Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DALE WAYNE WILLOUGHBY DDS (NPI 1700880556) is an individual oral and maxillofacial surgery provider in Kenosha, Wisconsin, licensed in Wisconsin (4998-015) and active in the NPI registry since June 2005. He has opted out of Medicare through March 19, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1700880556

Entity TypeIndividualMale

Primary Taxonomy1223S0112X

Provider Legal NameDALE WAYNE WILLOUGHBYCredential: DDS

Location Address6707 39TH AVEKenosha, WI 53142-7125

Mailing Address6707 39th AveKenosha, WI 53142-7125 · (262) 658-3559 · Fax (262) 653-1142

Phone(262) 658-3559

Fax(262) 658-0276

Sole ProprietorYes

Enumeration DateJune 9, 2005

Last NPPES UpdateJune 2, 2022

NPPES CertifiedJune 2, 2022

✔ NPI 1700880556 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

License✔ Licensed in WI · 4998-015

Definition

An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

6707 39TH AVE, Kenosha, WI 53142

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dale Wayne Willoughby Dds has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 19, 2024 through March 19, 2028.

Opt-Out Effective DateMarch 19, 2024

Opt-Out In Effect ThroughMarch 19, 2028Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53142 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$67.37 typical visit price

range $17.40 – $133.76

Typical copayment $16.84 (range $4.35 – $33.44)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KENOSHA ORAL SURGERY, S.C.

Dentist (Oral and Maxillofacial Surgery)

6707 39TH AVE
KENOSHA, WI 53142

Kenosha County (262) 658-3559

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dale Willoughby's NPI number?

The NPI number for Dale Willoughby is 1700880556. It was assigned to this individual provider in the NPPES registry on June 9, 2005.

Where is Dale Willoughby located?

Dale Willoughby practices at 6707 39th Ave, Kenosha, WI 53142. The listed phone number is (262) 658-3559.

What is Dale Willoughby's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Dale Willoughby enrolled in Medicare?

No. Dale Willoughby has opted out of Medicare through March 19, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Dale Willoughby was last updated on June 2, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.