MEDICARE: DR. MICHAEL ALAN WILLEN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30017180	OH

General Provider Information

NPI Number	:	1467423251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ALAN WILLEN D.D.S.

Provider Business Mailing Address
First Line	:	8210 MACEDONIA COMMONS BLVD
Second Line	:	SUITE #60
City	:	MACEDONIA
State	:	OH
Zip	:	44056-1860
Country	:	US
Telephone Number	:	300-468-1420
Fax Number	:	330-467-6878

Provider Business Practice Location Address
First Line	:	8210 MACEDONIA COMMONS BLVD
Second Line	:	SUITE #60
City	:	MACEDONIA
State	:	OH
Zip	:	44056-1860
Country	:	US
Telephone Number	:	300-468-1420
Fax Number	:	330-467-6878

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/08/2007

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