Provider Demographics
NPI:1134348725
Name:WILKERSON, DAMON CRIS (DDS)
Entity type:Individual
Prefix:DR
First Name:DAMON
Middle Name:CRIS
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14493 S PADRE ISLAND DR
Mailing Address - Street 2:SUITE A #446
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-5931
Mailing Address - Country:US
Mailing Address - Phone:361-947-2747
Mailing Address - Fax:
Practice Address - Street 1:1702 US HIGHWAY 181
Practice Address - Street 2:SUITE A-8
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-3854
Practice Address - Country:US
Practice Address - Phone:361-947-2747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO82811223X0400X
TX137071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics