Provider Demographics
NPI:1407140718
Name:WIKLE, AARON (DMD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:WIKLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 SW KAHLE RD
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17471 SHELLEY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-8084
Practice Address - Country:US
Practice Address - Phone:503-668-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD95751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice