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General NPI Number Information
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NPI Number | 1558639872
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Entity Type | Organization
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Legal Business Name | WILLIG DENTISTRY, PC
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Dates
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Enumeration Date | 12/01/2011
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 1299 HUSKY TRL
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City | WARSAW
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State | IN
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Zip | 46582-1956
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Country | US
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Telephone | 574-269-1200
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Fax | 574-269-3424
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Provider Business Mailing Address
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Address Line | 1600 HAWTHORNE CT
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City | WINONA LAKE
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State | IN
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Zip | 46590-1678
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Country | US
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Telephone | 574-269-9632
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Fax | 574-269-3424
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. CHRISTIAAN ANTHONY WILLIG
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Credential | DDS
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Telephone | 574-269-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | IN12010401A
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License Number State | IN
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