Provider Demographics
NPI:1245213552
Name:WILMES, DANIEL J (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:WILMES
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 1:20 WENTZVILLE MARKET PL
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-4430
Mailing Address - Country:US
Mailing Address - Phone:636-327-2050
Mailing Address - Fax:636-327-3999
Practice Address - Street 1:20 WENTZVILLE MARKET PL
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-4430
Practice Address - Country:US
Practice Address - Phone:636-327-2050
Practice Address - Fax:636-327-3999
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010129081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice