Provider Demographics
NPI:1356511034
Name:DR TALMADGE D. WILKINS IV D.M.D. PA
Entity Type:Organization
Organization Name:DR TALMADGE D. WILKINS IV D.M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TALMADGE
Authorized Official - Middle Name:DEWITT
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-648-9461
Mailing Address - Street 1:1391 SILVER BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-8860
Mailing Address - Country:US
Mailing Address - Phone:803-648-9461
Mailing Address - Fax:803-642-9452
Practice Address - Street 1:1391 SILVER BLUFF ROAD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7713
Practice Address - Country:US
Practice Address - Phone:803-648-9461
Practice Address - Fax:803-642-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2018-03-22
Deactivation Date:2018-03-22
Deactivation Code:
Reactivation Date:2018-03-22
Provider Licenses
StateLicense IDTaxonomies
SC40351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty