Individual
JERRY W WILKINS II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DA
Contact information
Practice address
12750 SE STARK ST BLDG E, PORTLAND, OR 97233-1539
(971) 347-3009
(971) 256-3277
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
000525
OR
126800000X
Dental Assistant
D160718103
WA
Other
Enumeration date
05/24/2019
Last updated
10/12/2020
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