Provider Demographics
NPI:1689778086
Name:WILD, MICHELLE UY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:UY
Last Name:WILD
Suffix:
Gender:F
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:CMR 402
Mailing Address - Street 2:LANDSTUHL DENTAL ATIVITY
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09108
Mailing Address - Country:US
Mailing Address - Phone:06313-406-4446
Mailing Address - Fax:
Practice Address - Street 1:CMR 402
Practice Address - Street 2:LANDSTUHL DENTAL ATIVITY
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09108
Practice Address - Country:US
Practice Address - Phone:06313-406-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry