Provider Demographics
NPI:1730457151
Name:CHRISTIAAN A. WILLIG, DDS, PC
Entity Type:Organization
Organization Name:CHRISTIAAN A. WILLIG, DDS, PC
Other - Org Name:ORANGE DOOR DENTAL GROUP OF WARSAW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:WILLIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-293-5216
Mailing Address - Street 1:110 N NAPPANEE ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1956
Mailing Address - Country:US
Mailing Address - Phone:574-293-5216
Mailing Address - Fax:574-522-1239
Practice Address - Street 1:110 N NAPPANEE ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1956
Practice Address - Country:US
Practice Address - Phone:574-293-5216
Practice Address - Fax:574-522-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ12010401A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty