Provider Demographics
NPI:1295152262
Name:WILDMAN, CHERYL MARIE (CDA)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:MARIE
Last Name:WILDMAN
Suffix:
Gender:F
Credentials:CDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 SE REDBUD PL
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-8399
Mailing Address - Country:US
Mailing Address - Phone:330-321-2616
Mailing Address - Fax:
Practice Address - Street 1:2640 MINER ROAD
Practice Address - Street 2:WEEKS DENTAL CLINIC
Practice Address - City:FT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503
Practice Address - Country:US
Practice Address - Phone:580-442-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant