Individual
KEITH I. WILKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
7600 W US HIGHWAY 50, SALIDA, CO 81201-9344
(719) 539-2587
(719) 539-4169
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401417729
VA
122300000X
Dentist
4375
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02073757
—
CO
Enumeration date
04/03/2007
Last updated
08/09/2022
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