MEDICARE: JOHN WILKINSON 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	23029	TX

General Provider Information

NPI Number	:	1578623294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WILKINSON DMD

Provider Business Mailing Address
First Line	:	2900 S HULEN ST STE 30
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1511
Country	:	US
Telephone Number	:	817-732-6622
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 S HULEN ST STE 30
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1511
Country	:	US
Telephone Number	:	817-732-6622
Fax Number	:

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	10/25/2024

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