Provider Demographics
NPI:1376975680
Name:WILDING, JAKE THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAKE
Middle Name:THOMAS
Last Name:WILDING
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:PERKINS DENTAL CLINIC
Mailing Address - Street 2:33001 BATTALION AVE.
Mailing Address - City:FORT CAVAZOS
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:254-287-3319
Mailing Address - Fax:
Practice Address - Street 1:TINGAY DENTAL CLINIC
Practice Address - Street 2:320 W HOSPITAL RD
Practice Address - City:FT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30509
Practice Address - Country:US
Practice Address - Phone:706-787-5102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8726975-9922122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist