Provider Demographics
NPI:1255786380
Name:THEODORE J WILLMANN DDS INC
Entity type:Organization
Organization Name:THEODORE J WILLMANN DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-586-4738
Mailing Address - Street 1:1304 MEADOWVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-1200
Mailing Address - Country:US
Mailing Address - Phone:419-586-4738
Mailing Address - Fax:419-586-5222
Practice Address - Street 1:1304 MEADOWVIEW DR
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-1200
Practice Address - Country:US
Practice Address - Phone:419-586-4738
Practice Address - Fax:419-586-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023069122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty