Provider Demographics
NPI:1679864631
Name:PETER F WILK D.D.S.
Entity Type:Organization
Organization Name:PETER F WILK D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-673-7826
Mailing Address - Street 1:1163 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-2207
Mailing Address - Country:US
Mailing Address - Phone:262-673-7826
Mailing Address - Fax:
Practice Address - Street 1:1163 GRAND AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-2207
Practice Address - Country:US
Practice Address - Phone:262-673-7826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI500126315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty