Individual
DR. SAMUEL DAVID WILLENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
2160 S 1ST AVE, C/O DEPT. OF SURGERY, DIVISION OF DENTAL AND ORAL MED, MAYWOOD, IL 60153-3328
(708) 327-3436
(708) 327-3489
Mailing address
2160 S 1ST AVE, C/O DEPT. OF SURGERY, DIVISION OF DENTAL AND ORAL MED, MAYWOOD, IL 60153-3328
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019028293
IL
Other
Enumeration date
05/26/2010
Last updated
05/26/2010
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