Provider Demographics
NPI:1043486228
Name:WILEMAN, FRANKLIN FREDRICK (RDH)
Entity Type:Individual
Prefix:MR
First Name:FRANKLIN
Middle Name:FREDRICK
Last Name:WILEMAN
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 LLOYD CT
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:WI
Mailing Address - Zip Code:54423-9427
Mailing Address - Country:US
Mailing Address - Phone:715-592-4704
Mailing Address - Fax:
Practice Address - Street 1:1234 LLOYD COURT
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:WI
Practice Address - Zip Code:54423
Practice Address - Country:US
Practice Address - Phone:715-592-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6141-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33806300Medicaid