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Individual

DR. DAVID MARK WILLEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
2775 BISHOP RD, SUITE C, WICKLIFFE, OH 44092-2683
(440) 944-7775
(440) 944-7887
Mailing address
2775 BISHOP RD, SUITE C, WICKLIFFE, OH 44092-2683
(440) 944-7775
(440) 944-7887

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30014345
OH
1223G0001X
General Practice Dentistry
014345
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
34-1910479
TAX ID
Enumeration date
12/12/2006
Last updated
09/21/2016
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