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General NPI Number Information
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NPI Number | 1710307061
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Entity Type | Organization
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Legal Business Name | MARK W. WILHELM DMD, MSD, PA
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Dates
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Enumeration Date | 04/24/2014
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 6861 UPPER AFTON RD SUITE 101
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City | WOODBURY
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State | MN
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Zip | 55125-4417
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Country | US
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Telephone | 651-227-2427
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Fax | 651-224-7414
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Provider Business Mailing Address
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Address Line | 6861 UPPER AFTON RD SUITE 101
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City | WOODBURY
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State | MN
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Zip | 55125-4417
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Country | US
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Telephone | 651-227-2427
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Fax | 651-224-7414
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK WILHELM
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Credential | DMD, MSD
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Telephone | 651-227-2427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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