Individual
ROBERT ALAN WIGHTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
20 5TH ST SE, COOK, MN 55723-9702
(218) 666-5958
Mailing address
20 5TH ST SE, COOK, MN 55723
(218) 666-5958
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D13787
MN
Other
Enumeration date
02/09/2016
Last updated
07/22/2017
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