Healthcare Provider Details

I. General information

NPI: 1598939647
Provider Name (Legal Business Name): DONALD NONE WILLEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2008
Last Update Date: 04/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 W STATE RD
CLEVES OH
45002-1044
US

IV. Provider business mailing address

35 W STATE RD
CLEVES OH
45002-1044
US

V. Phone/Fax

Practice location:
  • Phone: 513-941-2000
  • Fax: 513-941-2042
Mailing address:
  • Phone: 513-941-2000
  • Fax: 513-941-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14909
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14909
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: