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NPI Code Detail

MEDICARE: WIKLE DENTISTRY LLC

MEDICARE: WIKLE DENTISTRY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryD9575OR

General Provider Information

NPI Number : 1174997142
Entity Type Code : Organization
Provider Name (Legal Business Name) : WIKLE DENTISTRY LLC
Provider Business Mailing Address
First Line : 3900 DOUGLAS WAY
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-3446
Country : US
Telephone Number : 503-636-8446
Fax Number : 503-636-4446
Provider Business Practice Location Address
First Line : 3900 DOUGLAS WAY
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-3446
Country : US
Telephone Number : 503-636-8446
Fax Number : 503-636-4446
Authorized Official
Title or Position : REGISTERED AGENT/MEMBER/MANAGER
Name : DR. AARON WIKLE
Credential : D.M.D.
Telephone Number : 503-726-8295
Provider Enumeration Date : 11/13/2015
Last Update Date : 11/13/2015

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Directions to “WIKLE DENTISTRY LLC ” Practice Location

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