Individual
DR. MITCHELL R. WILKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
PO BOX 187, DULCE, NM 87528-0187
(575) 759-3291
(575) 759-3532
Mailing address
PO BOX 187, DULCE, NM 87528-0187
(575) 759-3291
(575) 759-3532
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
15881
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0900169-03
—
TX
05
—
0900169-04
—
TX
01
—
89D015
BLUE SHIELD
TX
01
—
P00214022
RR/MEDICARE
TX
Enumeration date
04/24/2006
Last updated
10/18/2017
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