Healthcare Provider Details

I. General information

NPI: 1629290242
Provider Name (Legal Business Name): KIM LOREN WILKINSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13851 QUAIL POINTE DR
OKLAHOMA CITY OK
73134-1021
US

IV. Provider business mailing address

13851 QUAIL POINTE DR
OKLAHOMA CITY OK
73134-1021
US

V. Phone/Fax

Practice location:
  • Phone: 405-242-2083
  • Fax: 405-242-2084
Mailing address:
  • Phone: 405-242-2083
  • Fax: 405-242-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number52
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: