Provider Demographics
NPI:1245332360
Name:STEPHEN W. WILKMAN, DDS, PC
Entity type:Organization
Organization Name:STEPHEN W. WILKMAN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WILKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-444-1813
Mailing Address - Street 1:1840 FOLSOM ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5712
Mailing Address - Country:US
Mailing Address - Phone:303-444-1813
Mailing Address - Fax:
Practice Address - Street 1:1840 FOLSOM ST STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5712
Practice Address - Country:US
Practice Address - Phone:303-444-1813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty