Organization
TRACY L. WILKERSON, DDS, PLLC
Active
Other names
Children's Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY LYNN WILKERSON DDS (PEDIATRIC SPECIALIST)
(304) 345-0541
Entity
Organization
Contact information
Practice address
1400 KANAWHA BLVD E, CHARLESTON, WV 25301-3002
(304) 345-0541
(304) 345-8718
Mailing address
1400 KANAWHA BLVD E, CHARLESTON, WV 25301-3002
(304) 345-0541
(304) 345-8718
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3529
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528024460
INDIVIDUAL NPI
WV
05
—
3810005586
—
WV
05
—
4005111000
—
WV
Enumeration date
03/28/2007
Last updated
08/22/2020
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