Healthcare Provider Details

I. General information

NPI: 1265662902
Provider Name (Legal Business Name): SARAH L WILLMANN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 MEADOWVIEW DRIVE
CELINA OH
45822-1132
US

IV. Provider business mailing address

1304 MEADOWVIEW DRIVE
CELINA OH
45822-1132
US

V. Phone/Fax

Practice location:
  • Phone: 419-586-4738
  • Fax: 419-586-5222
Mailing address:
  • Phone: 419-586-4738
  • Fax: 419-586-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.023069
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: