Healthcare Provider Details

I. General information

NPI: 1639239577
Provider Name (Legal Business Name): CHRISTOPHER G WILKINSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22703 BOTHELL EVERETT HWY STE E
BOTHELL WA
98021-8494
US

IV. Provider business mailing address

16770 315TH PL NE
DUVALL WA
98019-7746
US

V. Phone/Fax

Practice location:
  • Phone: 425-488-1480
  • Fax: 425-489-9997
Mailing address:
  • Phone: 253-905-5770
  • Fax: 425-489-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00007912
License Number StateWA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: