Provider Demographics
NPI:1255666590
Name:WILLETTS, DALE WILLIAM (TECHNICIAN)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:WILLIAM
Last Name:WILLETTS
Suffix:
Gender:M
Credentials:TECHNICIAN
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:WILLETTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TECHNICIAN
Mailing Address - Street 1:3733 RIVERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-3159
Mailing Address - Country:US
Mailing Address - Phone:714-914-6180
Mailing Address - Fax:865-233-7747
Practice Address - Street 1:3733 RIVERBROOK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:TN
Practice Address - Zip Code:37777
Practice Address - Country:US
Practice Address - Phone:714-914-6180
Practice Address - Fax:865-233-7747
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant