Provider Demographics
NPI:1922362748
Name:WILDER, CATHERINE RENEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:RENEE
Last Name:WILDER
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 1:24207 KINGSLAND BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494
Mailing Address - Country:US
Mailing Address - Phone:281-396-4366
Mailing Address - Fax:281-396-4367
Practice Address - Street 1:24207 KINGSLAND BOULEVARD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:281-396-4366
Practice Address - Fax:281-396-4367
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice