Individual
DR. JAKE THOMAS WILDING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
US ARMY DENTAL HEALTH ACTIVITY, 36000 SHOEMAKER LANE, SUITE 1051, FORT CAVAZOS, TX 76544-7654
(254) 287-3105
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(800) 994-0371
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
39234
TX
122300000X
Dentist
8726975-9922
UT
1223P0700X
Prosthodontics
Primary
8726975-9922
UT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
39234
TX
Other
Enumeration date
08/09/2013
Last updated
09/23/2025
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