Provider Demographics
NPI:1558701797
Name:WILTON, JANICE (RDH)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:WILTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:
Other - Last Name:FINCHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:9346 NW 41ST CT
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226-2085
Mailing Address - Country:US
Mailing Address - Phone:515-965-0584
Mailing Address - Fax:
Practice Address - Street 1:15910 W COMPANY LAKE RD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-5320
Practice Address - Country:US
Practice Address - Phone:715-934-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3229-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist