Provider Demographics
NPI:1801880422
Name:WILLIG, CHRISTIAAN ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAAN
Middle Name:ANTHONY
Last Name:WILLIG
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 1:110 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
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010401A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN13128866432Medicaid