Provider Demographics
NPI:1841296639
Name:WILKINSON, ALAN D (DMD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 S LIMESTONE STE E214
Mailing Address - Street 2:UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-5500
Mailing Address - Fax:859-323-0001
Practice Address - Street 1:134 EVERGREEN RD STE 201
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1486
Practice Address - Country:US
Practice Address - Phone:502-200-5325
Practice Address - Fax:502-434-5924
Is Sole Proprietor?:No
Enumeration Date:2005-06-26
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4289122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU17282Medicare UPIN
KY0981401Medicare PIN