Provider Demographics
NPI:1689956658
Name:WILK, ROCHELLE NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROCHELLE
Middle Name:NICOLE
Last Name:WILK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:TX
Mailing Address - Zip Code:78648-2624
Mailing Address - Country:US
Mailing Address - Phone:830-875-6603
Mailing Address - Fax:830-875-6614
Practice Address - Street 1:111 S LAUREL AVE
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:TX
Practice Address - Zip Code:78648-2624
Practice Address - Country:US
Practice Address - Phone:830-875-6603
Practice Address - Fax:830-875-6614
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice