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General NPI Number Information
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NPI Number | 1558989749
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Entity Type | Individual
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Provider Name | AUSTIN RAY WILKIE DDS
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Gender | Male
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 330 HIGHWAY 5 N STE 10
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-3039
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Country | US
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Telephone | 870-424-4670
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Fax | 870-425-4674
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Provider Business Mailing Address
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Address Line | 330 HIGHWAY 5 N STE 10
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-3039
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Country | US
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Telephone | 870-424-4670
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Fax | 870-425-4674
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4438
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License Number State | AR
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