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General NPI Number Information
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NPI Number | 1477794857
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Entity Type | Individual
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Provider Name | RAYMOND CARL WILBUR SR. DDS
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Gender | Male
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 108 N 3RD AVE
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City | VIRGINIA
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State | MN
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Zip | 55792-2519
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Country | US
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Telephone | 218-741-9251
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Fax | 218-741-1747
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Provider Business Mailing Address
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Address Line | PO BOX 1247
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City | VIRGINIA
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State | MN
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Zip | 55792-1247
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Country | US
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Telephone | 218-741-9251
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Fax | 218-741-1747
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 10169
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D10169
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License Number State | MN
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