Provider Demographics
NPI:1003669656
Name:WILMES DENTAL, INC.
Entity Type:Organization
Organization Name:WILMES DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WILMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS FAGD
Authorized Official - Phone:563-382-3657
Mailing Address - Street 1:108 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-1319
Mailing Address - Country:US
Mailing Address - Phone:563-382-3657
Mailing Address - Fax:563-382-0739
Practice Address - Street 1:108 5TH AVE
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-1319
Practice Address - Country:US
Practice Address - Phone:563-382-3657
Practice Address - Fax:563-382-0739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental