Fulton Dental Associates PC
Organization Active NPI Dentist · Fulton, IL
NPI 1154590040 · NPPES record last updated Sep 23, 2008
Key facts
- NPI
- 1154590040
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- Legal business name
- FULTON DENTAL ASSOCIATES PC
- Practice address
- 1130 17TH St
Fulton, IL 61252-2008 - Phone
- (815) 589-4007
- Fax
- (815) 589-4897
- NPI assigned
- Feb 25, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. William Michael Wilkin, D.D.S.
- Title
- Owner
- Phone
- (815) 589-4007
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | IL | Yes |
Addresses
Primary practice location
1130 17TH St
Fulton, IL 61252-2008
Mailing address
1130 17TH St
Fulton, IL 61252-2008
Phone (815) 589-4007
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1004473 | Medicaid | IL | |
| 1004190 | Medicaid | IL |
Other providers in Fulton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2008. 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.