Organization
KAW PC
Active
Other names
Chandler Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL J WILGUESS DDS (OWNER)
(405) 258-2684
Entity
Organization
Contact information
Practice address
1516 S IOWA, CHANDLER, OK 74834
(405) 258-2684
(405) 258-5353
Mailing address
PO BOX 249, CHANDLER, OK 74834
(405) 258-2684
(405) 258-5353
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5487
OK
1223G0001X
General Practice Dentistry
5503
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01307512
UNITED CONCORDIA
OK
01
—
310784561002
BLUE CROSS BLUE SHIELD
OK
01
—
445862194001
BLUE CROSS BLUE SHIELD
OK
Enumeration date
09/27/2007
Last updated
09/27/2007
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