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General NPI Number Information
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NPI Number | 1154590040
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Entity Type | Organization
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Legal Business Name | FULTON DENTAL ASSOCIATES PC
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 1130 17TH ST
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City | FULTON
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State | IL
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Zip | 61252-2008
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Country | US
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Telephone | 815-589-4007
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Fax | 815-589-4897
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Provider Business Mailing Address
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Address Line | 1130 17TH ST
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City | FULTON
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State | IL
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Zip | 61252-2008
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Country | US
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Telephone | 815-589-4007
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Fax | 815-589-4897
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM MICHAEL WILKIN
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Credential | D.D.S.
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Telephone | 815-589-4007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | IL
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