Provider Demographics
NPI:1356513659
Name:WILKINSON FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:WILKINSON FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-228-3688
Mailing Address - Street 1:1200 NW JEFFERSON CT
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-6394
Mailing Address - Country:US
Mailing Address - Phone:816-228-3688
Mailing Address - Fax:816-228-5688
Practice Address - Street 1:1200 NW JEFFERSON CT
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-6394
Practice Address - Country:US
Practice Address - Phone:816-228-3688
Practice Address - Fax:816-228-5688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060141551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty