Provider Demographics
NPI:1942323589
Name:WILLMAN, BRADEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADEN
Middle Name:
Last Name:WILLMAN
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 1:1090 S STATE ROAD 135
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7367
Mailing Address - Country:US
Mailing Address - Phone:317-882-8899
Mailing Address - Fax:317-882-2260
Practice Address - Street 1:1090 S STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-7367
Practice Address - Country:US
Practice Address - Phone:317-882-8899
Practice Address - Fax:317-882-2260
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010287A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist