Provider Demographics
NPI:1497795082
Name:WILCK, JEROLD B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEROLD
Middle Name:B
Last Name:WILCK
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 1:680 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1817
Mailing Address - Country:US
Mailing Address - Phone:215-757-1574
Mailing Address - Fax:215-757-4909
Practice Address - Street 1:680 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1817
Practice Address - Country:US
Practice Address - Phone:215-757-1574
Practice Address - Fax:215-757-4909
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017386L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice