MEDICARE: DR. ROSCOE WILKS JR. DMD

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
1	1223G0001X	General Practice Dentistry	3797	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447435045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSCOE WILKS JR. DMD

Provider Business Mailing Address
First Line	:	2619 JASMINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-6017
Country	:	US
Telephone Number	:	504-304-0472
Fax Number	:

Provider Business Practice Location Address
First Line	:	2619 JASMINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-6017
Country	:	US
Telephone Number	:	504-304-0472
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	01/02/2008

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