Individual
DR. JOHN A WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1626 MORGAN ST, SUITE 3, KEOKUK, IA 52632
(319) 524-1477
(319) 524-7965
Mailing address
1626 MORGAN ST, SUITE 3, KEOKUK, IA 52632
(319) 524-1477
(319) 524-7965
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
05824
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05824
IA DENTAL LICENSE
IA
05
—
1089326
—
IA
01
—
38071
BLUE CROSS
—
Enumeration date
11/06/2006
Last updated
03/07/2023
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