Provider Demographics
NPI:1952523623
Name:STADEKER, WILKIE J (DDS)
Entity Type:Individual
Prefix:
First Name:WILKIE
Middle Name:J
Last Name:STADEKER
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 1:123 MARBLE MILL RD NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7954
Mailing Address - Country:US
Mailing Address - Phone:678-354-5119
Mailing Address - Fax:678-354-5191
Practice Address - Street 1:123 MARBLE MILL RD NW
Practice Address - Street 2:SUITE B
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7954
Practice Address - Country:US
Practice Address - Phone:678-354-5119
Practice Address - Fax:678-354-5191
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0114471223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics