Mitchell R. Wilkinson, DDS
Individual provider Active NPI Prosthodontics · Dulce, NM
NPI 1063478618 · NPPES record last updated Oct 18, 2017
Key facts
- NPI
- 1063478618
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Prosthodontics 1223P0700X
- License
- 15881 (TX)
- Practice address
- PO Box 187
Dulce, NM 87528-0187 - Phone
- (575) 759-3291
- Fax
- (575) 759-3532
- NPI assigned
- Apr 24, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 15881 | TX | Yes |
Addresses
Primary practice location
PO Box 187
Dulce, NM 87528-0187
Mailing address
PO Box 187
Dulce, NM 87528-0187
Phone (575) 759-3291
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0900169-03 | Medicaid | TX | |
| 89D015 | Other | TX | BLUE SHIELD |
| P00214022 | Other | TX | RR/MEDICARE |
| 0900169-04 | Medicaid | TX |
Other providers in Dulce, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.