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General NPI Number Information
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NPI Number | 1427215441
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Entity Type | Organization
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Legal Business Name | JOHN A. WILDE D.D.S. INC.
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1626 MORGAN ST
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City | KEOKUK
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State | IA
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Zip | 52632-3424
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Country | US
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Telephone | 319-524-1477
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Fax | 319-524-7965
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Provider Business Mailing Address
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Address Line | 1626 MORGAN ST
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City | KEOKUK
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State | IA
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Zip | 52632-3424
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Country | US
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Telephone | 319-524-1477
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Fax | 319-524-7965
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Authorized Official
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Title or Position | OFFICE ASSISTANT
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Name | BECKY L VOGEL
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Credential | RDA
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Telephone | 319-524-1477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 05824
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License Number State | IA
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