Provider Demographics
NPI:1770191173
Name:WILKERSON, TRENT DYLAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:DYLAN
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16001 LARUE RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39565-7717
Mailing Address - Country:US
Mailing Address - Phone:228-219-5777
Mailing Address - Fax:
Practice Address - Street 1:101 S PEARL ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-4110
Practice Address - Country:US
Practice Address - Phone:601-267-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4143-20122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist