Healthcare Provider Details

I. General information

NPI: 1568109643
Provider Name (Legal Business Name): DAN G WILKER DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 05/19/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 W ELM ST
LIMA OH
45807-2223
US

IV. Provider business mailing address

3390 W ELM ST
LIMA OH
45807-2223
US

V. Phone/Fax

Practice location:
  • Phone: 419-222-1726
  • Fax: 419-222-7122
Mailing address:
  • Phone: 419-222-1726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1790869758
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: KRISTA WRIGHT
Title or Position: CDA
Credential:
Phone: 419-222-1726