Provider Demographics
NPI:1972683704
Name:WILMERT, W JAMES (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:W JAMES
Middle Name:
Last Name:WILMERT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 PINE ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-2661
Mailing Address - Country:US
Mailing Address - Phone:217-732-8523
Mailing Address - Fax:217-732-9543
Practice Address - Street 1:113 PINE ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-2661
Practice Address - Country:US
Practice Address - Phone:217-732-8523
Practice Address - Fax:217-732-9543
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics