Provider Demographics
NPI:1578568929
Name:WILKINS, PHILIP CHARLES SR (DMD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:CHARLES
Last Name:WILKINS
Suffix:SR
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 1:124 N CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-1119
Mailing Address - Country:US
Mailing Address - Phone:803-635-6162
Mailing Address - Fax:803-635-1780
Practice Address - Street 1:124 N CONGRESS ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-1119
Practice Address - Country:US
Practice Address - Phone:803-635-6162
Practice Address - Fax:803-635-1780
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice