Provider Demographics
NPI:1982847240
Name:ABBOTT, WILMER A III (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILMER
Middle Name:A
Last Name:ABBOTT
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 S CORNWALL AVE
Mailing Address - Street 2:
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-2715
Mailing Address - Country:US
Mailing Address - Phone:609-823-0603
Mailing Address - Fax:609-823-3103
Practice Address - Street 1:26 S CORNWALL AVE
Practice Address - Street 2:
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-2715
Practice Address - Country:US
Practice Address - Phone:609-823-0603
Practice Address - Fax:609-823-3103
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01971000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist