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General NPI Number Information
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NPI Number | 1255786380
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Entity Type | Organization
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Legal Business Name | THEODORE J WILLMANN DDS INC
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 1304 MEADOWVIEW DR
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City | CELINA
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State | OH
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Zip | 45822-1200
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Country | US
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Telephone | 419-586-4738
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Fax | 419-586-5222
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Provider Business Mailing Address
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Address Line | 1304 MEADOWVIEW DR
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City | CELINA
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State | OH
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Zip | 45822-1200
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Country | US
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Telephone | 419-586-4738
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Fax | 419-586-5222
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Authorized Official
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Title or Position | VP
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Name | MRS. SARAH L WILLMANN
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Credential | DDS
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Telephone | 419-586-4738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.023069
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License Number State | OH
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