Provider Demographics
NPI:1598939647
Name:WILLEN, DONALD NONE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:NONE
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 1:35 W STATE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVES
Mailing Address - State:OH
Mailing Address - Zip Code:45002-1044
Mailing Address - Country:US
Mailing Address - Phone:513-941-2000
Mailing Address - Fax:513-941-2042
Practice Address - Street 1:35 W STATE RD
Practice Address - Street 2:
Practice Address - City:CLEVES
Practice Address - State:OH
Practice Address - Zip Code:45002-1044
Practice Address - Country:US
Practice Address - Phone:513-941-2000
Practice Address - Fax:513-941-2042
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-19
Last Update Date:2008-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14909122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE