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General NPI Number Information
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NPI Number | 1205777182
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Entity Type | Organization
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Legal Business Name | WOODBURY MODERN DENTISTRY, PC
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Dates
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Enumeration Date | 04/03/2026
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Last Update Date | 04/03/2026
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Provider Practice Location Address
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Address Line | 265 RADIO DR STE E
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City | WOODBURY
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State | MN
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Zip | 55125-5809
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Country | US
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Telephone | 612-294-6742
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Fax | 612-285-3884
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Provider Business Mailing Address
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Address Line | PO BOX 660041
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City | DALLAS
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State | TX
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Zip | 75266-0041
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Country | US
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Telephone | 714-845-8890
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Fax | 303-952-0892
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Authorized Official
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Title or Position | OWNER
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Name | MITCHELL C WILKINSON
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Credential | DDS
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Telephone | 612-294-6742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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