Provider Demographics
NPI:1497044291
Name:WILKES, DUSTIN VAN (DO)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:VAN
Last Name:WILKES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5310 HARVEST HILL RD STE 290
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5826
Mailing Address - Country:US
Mailing Address - Phone:214-420-0672
Mailing Address - Fax:214-736-0512
Practice Address - Street 1:1709 MARTIN DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086
Practice Address - Country:US
Practice Address - Phone:817-594-5880
Practice Address - Fax:806-977-9112
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9487207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program