Provider Demographics
NPI:1891463352
Name:WILKES, NICOLETTE D (DDS)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:D
Last Name:WILKES
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 1:131 BLACKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-9366
Mailing Address - Country:US
Mailing Address - Phone:484-269-3510
Mailing Address - Fax:
Practice Address - Street 1:957 BEN FRANKLIN HIGHWAY WEST
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518
Practice Address - Country:US
Practice Address - Phone:610-385-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0432851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice