Provider Demographics
NPI:1245418771
Name:WILDEY, WILLIAM LEONARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEONARD
Last Name:WILDEY
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 1:1750 CAVENDER DR
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3546
Mailing Address - Country:US
Mailing Address - Phone:817-268-8340
Mailing Address - Fax:817-268-3835
Practice Address - Street 1:1750 CAVENDER DR
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3546
Practice Address - Country:US
Practice Address - Phone:817-268-8340
Practice Address - Fax:817-268-3835
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153791223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics