Provider Demographics
NPI:1467423251
Name:WILLEN, MICHAEL ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:WILLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8210 MACEDONIA COMMONS BLVD
Mailing Address - Street 2:SUITE #60
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-1860
Mailing Address - Country:US
Mailing Address - Phone:300-468-1420
Mailing Address - Fax:330-467-6878
Practice Address - Street 1:8210 MACEDONIA COMMONS BLVD
Practice Address - Street 2:SUITE #60
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1860
Practice Address - Country:US
Practice Address - Phone:300-468-1420
Practice Address - Fax:330-467-6878
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300171801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice