MEDICARE: DR. KIM LOREN WILKINSON DDS

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	1223E0200X	Endodontics	52	OK

General Provider Information

NPI Number	:	1629290242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIM LOREN WILKINSON DDS

Provider Business Mailing Address
First Line	:	13851 QUAIL POINTE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1021
Country	:	US
Telephone Number	:	405-242-2083
Fax Number	:	405-242-2084

Provider Business Practice Location Address
First Line	:	13851 QUAIL POINTE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1021
Country	:	US
Telephone Number	:	405-242-2083
Fax Number	:	405-242-2084

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	12/21/2015

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