Provider Demographics
NPI:1720453277
Name:DAVID A. WILKINSON DDS MSD, P.A.
Entity Type:Organization
Organization Name:DAVID A. WILKINSON DDS MSD, P.A.
Other - Org Name:SHERMAN BRISCOE WILKINSON ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-597-6372
Mailing Address - Street 1:6820 OAK HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0539
Mailing Address - Country:US
Mailing Address - Phone:903-597-6372
Mailing Address - Fax:903-592-8482
Practice Address - Street 1:6820 OAK HILL BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0539
Practice Address - Country:US
Practice Address - Phone:903-597-6372
Practice Address - Fax:903-592-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27915261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental