Provider Demographics
NPI:1700227576
Name:WILENSKY, NEIL STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:STEVEN
Last Name:WILENSKY
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 1:895 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5441
Mailing Address - Country:US
Mailing Address - Phone:707-961-4270
Mailing Address - Fax:707-961-4275
Practice Address - Street 1:895 RIVER DR
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5441
Practice Address - Country:US
Practice Address - Phone:707-961-4270
Practice Address - Fax:707-961-4275
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA199901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice