Provider Demographics
NPI:1881009397
Name:WILDMAN, GERALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:WILDMAN
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 1:49 N FEDERAL HWY
Mailing Address - Street 2:#218
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4304
Mailing Address - Country:US
Mailing Address - Phone:954-295-3302
Mailing Address - Fax:
Practice Address - Street 1:49 N FEDERAL HWY
Practice Address - Street 2:#218
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-4304
Practice Address - Country:US
Practice Address - Phone:954-295-3302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist