Provider Demographics
NPI:1801907712
Name:WILKEN, CRESCENTHIA ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:CRESCENTHIA
Middle Name:ANN
Last Name:WILKEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 40TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421
Mailing Address - Country:US
Mailing Address - Phone:763-788-1625
Mailing Address - Fax:
Practice Address - Street 1:700 40TH AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421
Practice Address - Country:US
Practice Address - Phone:763-788-1625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8733122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist