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Organization
ESSENTIAL DERMATOLOGY AND COSMETIC SURGERY PLLC
Active
Organization
ESSENTIAL DERMATOLOGY AND COSMETIC SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DUSTIN VAN WILKES D.O. (OWNER/CEO)
(806) 241-4195
Entity
Organization
Contact information
Practice address
1105 SANTA FE DRIVE, STE 105, WEATHERFORD, TX 76086-5852
(806) 241-4195
Mailing address
1105 SANTA FE DRIVE, STE 105, WEATHERFORD, TX 76086-5852
(806) 241-4195
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
NULL
Other
Enumeration date
01/30/2015
Last updated
03/28/2015
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