Provider Demographics
NPI:1417034935
Name:F. ROBERT WILKIN D.D.S., LTD
Entity Type:Organization
Organization Name:F. ROBERT WILKIN D.D.S., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:F
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WILKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-769-6088
Mailing Address - Street 1:4801 W PETERSON AVE
Mailing Address - Street 2:614
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5713
Mailing Address - Country:US
Mailing Address - Phone:773-769-6088
Mailing Address - Fax:773-930-4867
Practice Address - Street 1:4801 W PETERSON AVE
Practice Address - Street 2:614
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5713
Practice Address - Country:US
Practice Address - Phone:773-769-6088
Practice Address - Fax:773-930-4867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01917750261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental