Provider Demographics
NPI:1295139046
Name:WIKLE, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WIKLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 OXMOOR GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-6448
Mailing Address - Country:US
Mailing Address - Phone:662-255-5441
Mailing Address - Fax:
Practice Address - Street 1:107 OXMOOR GLEN CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-6448
Practice Address - Country:US
Practice Address - Phone:662-255-5441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist