Organization
JOHN A. WILDE D.D.S. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BECKY L VOGEL RDA (OFFICE ASSISTANT)
(319) 524-1477
Entity
Organization
Contact information
Practice address
1626 MORGAN ST, KEOKUK, IA 52632-3424
(319) 524-1477
(319) 524-7965
Mailing address
1626 MORGAN ST, KEOKUK, IA 52632-3424
(319) 524-1477
(319) 524-7965
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
05824
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05824
IOWA DENTAL LICENSE
IA
05
—
1089326
—
IA
01
—
38071
BCBS PROVIDER#
IA
Enumeration date
05/19/2008
Last updated
03/07/2023
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