Provider Demographics
NPI:1518132109
Name:ROBERT M. WILKINSON, JR., D.D.S., P.A.
Entity Type:Organization
Organization Name:ROBERT M. WILKINSON, JR., D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MCLAIN
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-765-9247
Mailing Address - Street 1:1086 WHITAKER RAOD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4823
Mailing Address - Country:US
Mailing Address - Phone:336-765-9247
Mailing Address - Fax:336-765-6960
Practice Address - Street 1:1086 WHITAKER RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4823
Practice Address - Country:US
Practice Address - Phone:336-765-9247
Practice Address - Fax:336-765-6960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5784261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC99290Medicaid