Provider Demographics
NPI:1710307061
Name:MARK W. WILHELM DMD, MSD, PA
Entity Type:Organization
Organization Name:MARK W. WILHELM DMD, MSD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:651-227-2427
Mailing Address - Street 1:6861 UPPER AFTON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4417
Mailing Address - Country:US
Mailing Address - Phone:651-227-2427
Mailing Address - Fax:651-224-7414
Practice Address - Street 1:6861 UPPER AFTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4417
Practice Address - Country:US
Practice Address - Phone:651-227-2427
Practice Address - Fax:651-224-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier