Provider Demographics
NPI:1174043780
Name:WILEN, BRYCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:
Last Name:WILEN
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 1:1310 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1525
Mailing Address - Country:US
Mailing Address - Phone:605-642-7760
Mailing Address - Fax:
Practice Address - Street 1:1310 NORTH AVE
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1525
Practice Address - Country:US
Practice Address - Phone:605-642-7760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-24
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD1162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist