Provider Demographics
NPI:1497862056
Name:WILCHER, DERRICK KEITH (DMD)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:KEITH
Last Name:WILCHER
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 1:9141 HOUNDSBAY DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8471
Mailing Address - Country:US
Mailing Address - Phone:334-396-7820
Mailing Address - Fax:
Practice Address - Street 1:210 WINTON BLOUNT LOOP
Practice Address - Street 2:DENTAL ASSOCIATES OF EAST MONTGOMERY
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-0000
Practice Address - Country:US
Practice Address - Phone:334-272-1677
Practice Address - Fax:334-272-8385
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48231223G0001X
GA0088181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice