MEDICARE: DR. MITCHELL R. WILKINSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	15881	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00214022	OTHER	TX	RR/MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	89D015	OTHER	TX	BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063478618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL R. WILKINSON DDS

Provider Business Mailing Address
First Line	:	PO BOX 187
Second Line	:
City	:	DULCE
State	:	NM
Zip	:	87528-0187
Country	:	US
Telephone Number	:	575-759-3291
Fax Number	:	575-759-3532

Provider Business Practice Location Address
First Line	:	PO BOX 187
Second Line	:
City	:	DULCE
State	:	NM
Zip	:	87528-0187
Country	:	US
Telephone Number	:	575-759-3291
Fax Number	:	575-759-3532

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	10/18/2017

Similar Medicare Providers

1750388963 — DULCE HEALTH CENTER
Practice Location Address:

500 NORTH MUNDO
DULCE, NM
87528-0187

Practice Phone: 505-759-3291
Practice Fax: 505-759-3532

1982653036 — ERIC J POLCZYNSKI RPH
Practice Location Address:

JICARILLA SERVICE UNIT , 12000 STONE LAKE ROAD
DULCE, NM
87528-0187

Practice Phone: 505-759-3291
Practice Fax: 505-759-7288

1265460851 — MARICELA BONILLA O.D.
Practice Location Address:

500 NORTH MUNDO
DULCE, NM
87528-0187

Practice Phone: 575-759-7281
Practice Fax: 575-759-3651

1134158405 — SIRPA T. AUTIO MD
Practice Location Address:

500 N MUNDO
DULCE, NM
87528-0187

Practice Phone: 575-759-3291
Practice Fax: 575-759-3532

1194747279 — MRS. SHARON HOPE GREACEN MT(ASCP)
Practice Location Address:

12000 STONE LAKE DRIVE , LABORATORY
DULCE, NM
87528-0187

Practice Phone: 505-759-7218
Practice Fax:

1467475939 — MS. DIANE P HOLZEM RN,C
Practice Location Address:

12000 STONE LAKE ROAD
DULCE, NM
87528-0187

Practice Phone: 505-759-7233
Practice Fax: 505-759-7294

Directions to “ DR. MITCHELL R. WILKINSON DDS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.