Provider Demographics
NPI:1619028941
Name:WILKERSON, WILLIAM CHAD (DDS,PLLC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHAD
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:DDS,PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CRESTVIEW PLZ STE C
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4305
Mailing Address - Country:US
Mailing Address - Phone:501-985-0180
Mailing Address - Fax:501-985-0416
Practice Address - Street 1:9 CRESTVIEW PLZ STE C
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4305
Practice Address - Country:US
Practice Address - Phone:501-985-0180
Practice Address - Fax:501-985-0416
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR33651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice