Provider Demographics
NPI:1922179670
Name:WILKINS, RONALD GLENN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GLENN
Last Name:WILKINS
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 1:4020 S 700 E
Mailing Address - Street 2:#1
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2186
Mailing Address - Country:US
Mailing Address - Phone:801-263-2633
Mailing Address - Fax:801-263-3572
Practice Address - Street 1:4020 S 700 E
Practice Address - Street 2:#1
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2186
Practice Address - Country:US
Practice Address - Phone:801-263-2633
Practice Address - Fax:801-263-3572
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14020111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice