Healthcare Provider Details

I. General information

NPI: 1689778086
Provider Name (Legal Business Name): MICHELLE UY WILD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OPC 2 BOX 60
APO AE
09094-9001
US

IV. Provider business mailing address

OPC 2 BOX 60
APO AE
09094-9001
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-2609
  • Fax:
Mailing address:
  • Phone: 314-479-2609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDT-2877
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: