Provider Demographics
NPI:1013048362
Name:WILLMANN, THEODORE JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:JOHN
Last Name:WILLMANN
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 1:570 E KREMER HOYING RD # D
Mailing Address - Street 2:
Mailing Address - City:SAINT HENRY
Mailing Address - State:OH
Mailing Address - Zip Code:45883-9613
Mailing Address - Country:US
Mailing Address - Phone:419-678-8000
Mailing Address - Fax:419-678-4409
Practice Address - Street 1:570 E KREMER HOYING RD # D
Practice Address - Street 2:
Practice Address - City:SAINT HENRY
Practice Address - State:OH
Practice Address - Zip Code:45883-9613
Practice Address - Country:US
Practice Address - Phone:419-678-8000
Practice Address - Fax:419-678-4409
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH166581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH16658OtherDENTAL LICENSE