Provider Demographics
NPI:1154667269
Name:ARTHUR E. WILK, DDS, P.C.
Entity Type:Organization
Organization Name:ARTHUR E. WILK, DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-669-3219
Mailing Address - Street 1:34 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-2037
Mailing Address - Country:US
Mailing Address - Phone:860-669-3219
Mailing Address - Fax:
Practice Address - Street 1:34 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2037
Practice Address - Country:US
Practice Address - Phone:860-669-3219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT64991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002064997Medicaid
CTT22434Medicare UPIN