Provider Demographics
NPI:1629290242
Name:WILKINSON, KIM LOREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:LOREN
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13851 QUAIL POINTE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1021
Mailing Address - Country:US
Mailing Address - Phone:405-242-2083
Mailing Address - Fax:405-242-2084
Practice Address - Street 1:13851 QUAIL POINTE DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1021
Practice Address - Country:US
Practice Address - Phone:405-242-2083
Practice Address - Fax:405-242-2084
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK521223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics