Healthcare Provider Details

I. General information

NPI: 1932257060
Provider Name (Legal Business Name): PAUL WAYNE WILKES DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1214
US

IV. Provider business mailing address

1201 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1214
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-7744
  • Fax: 405-271-7799
Mailing address:
  • Phone: 405-271-7744
  • Fax: 405-271-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number3789
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: