Individual
DR. JOHN D WILDGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDSPC
Contact information
Practice address
128 SOUTH MAIN STREET, LAURIE, MO 65038
(573) 374-5739
(573) 374-8901
Mailing address
128 SOUTH MAIN STREET, P.O. BOX 1083, LAURIE, MO 65038
(573) 374-5739
(573) 374-8901
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
013788
MO
Other
Enumeration date
12/26/2007
Last updated
12/26/2007
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