Individual
MICHELLE D WILKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
17 YOUNG ST, WORCESTER, MA 01603-1420
(508) 753-6777
Mailing address
790 BOYLSTON ST APT 5J, BOSTON, MA 02199-7905
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
1855276
MA
1223P0221X
Pediatric Dentistry
7194
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89902HM
—
NC
01
—
902HM
BLUE CROSS BLUE SHIELD NC
—
Enumeration date
12/08/2006
Last updated
11/10/2011
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