Provider Demographics
NPI:1558639872
Name:WILLIG DENTISTRY, PC
Entity type:Organization
Organization Name:WILLIG DENTISTRY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:WILLIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-269-1200
Mailing Address - Street 1:1600 HAWTHORNE CT
Mailing Address - Street 2:
Mailing Address - City:WINONA LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46590-1678
Mailing Address - Country:US
Mailing Address - Phone:574-269-9632
Mailing Address - Fax:574-269-3424
Practice Address - Street 1:1299 HUSKY TRL
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582-1956
Practice Address - Country:US
Practice Address - Phone:574-269-1200
Practice Address - Fax:574-269-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ12010401A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty