Provider Demographics
NPI:1144934373
Name:WILLARD, DANIELLE ANN (RDH)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ANN
Last Name:WILLARD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6816 S LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BARTONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61607-8953
Mailing Address - Country:US
Mailing Address - Phone:309-267-4779
Mailing Address - Fax:
Practice Address - Street 1:6816 S LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BARTONVILLE
Practice Address - State:IL
Practice Address - Zip Code:61607-8953
Practice Address - Country:US
Practice Address - Phone:309-267-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020014960124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist