Provider Demographics
NPI:1184830135
Name:WILKES, ROBERT J (DDS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:WILKES
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 1:510 E MCALPINE ST
Mailing Address - Street 2:
Mailing Address - City:NAVASOTA
Mailing Address - State:TX
Mailing Address - Zip Code:77868-3646
Mailing Address - Country:US
Mailing Address - Phone:936-825-7983
Mailing Address - Fax:936-825-2574
Practice Address - Street 1:510 E MCALPINE ST
Practice Address - Street 2:
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868-3646
Practice Address - Country:US
Practice Address - Phone:936-825-7983
Practice Address - Fax:936-825-2574
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice