Provider Demographics
NPI:1912915992
Name:WILKES, BRIAN ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ERIC
Last Name:WILKES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 OLD SWEDE RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1208
Mailing Address - Country:US
Mailing Address - Phone:610-385-0022
Mailing Address - Fax:610-385-0025
Practice Address - Street 1:515 OLD SWEDE RD
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-1208
Practice Address - Country:US
Practice Address - Phone:610-385-0022
Practice Address - Fax:610-385-0025
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-028367L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist