Individual
TRACY LYNN WILKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3529
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4005111000
—
WV
Enumeration date
04/20/2006
Last updated
08/18/2008
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