Provider Demographics
NPI:1790984169
Name:WILKENS, NANCY MARGUERITE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:MARGUERITE
Last Name:WILKENS
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 1:447 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2209
Mailing Address - Country:US
Mailing Address - Phone:631-584-6660
Mailing Address - Fax:
Practice Address - Street 1:447 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2209
Practice Address - Country:US
Practice Address - Phone:631-584-6660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0476341223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics