Provider Demographics
NPI:1245431881
Name:WILKES, JAMES STUART (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STUART
Last Name:WILKES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1460 RUSSELL ROAD
Mailing Address - Street 2:#101
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1271
Mailing Address - Country:US
Mailing Address - Phone:610-647-5778
Mailing Address - Fax:610-647-5882
Practice Address - Street 1:1460 RUSSELL ROAD
Practice Address - Street 2:#101
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1271
Practice Address - Country:US
Practice Address - Phone:610-647-5778
Practice Address - Fax:610-647-5882
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0168751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics