Healthcare Provider Details

I. General information

NPI: 1467423251
Provider Name (Legal Business Name): MICHAEL ALAN WILLEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 MACEDONIA COMMONS BLVD SUITE #60
MACEDONIA OH
44056-1860
US

IV. Provider business mailing address

8210 MACEDONIA COMMONS BLVD SUITE #60
MACEDONIA OH
44056-1860
US

V. Phone/Fax

Practice location:
  • Phone: 300-468-1420
  • Fax: 330-467-6878
Mailing address:
  • Phone: 300-468-1420
  • Fax: 330-467-6878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30017180
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: