Organization
JOHN D WILDGEN DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN D WILDGEN DDS (PRESIDENT)
(573) 374-5739
Entity
Organization
Contact information
Practice address
128 S MAIN STREET, LAURIE, MO 65038-1083
(573) 374-5739
(573) 374-8901
Mailing address
PO BOX 1083, LAURIE, MO 65038-1083
(573) 374-5739
(573) 374-8901
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0133788
MO
Other
Enumeration date
08/29/2006
Last updated
12/17/2007
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