Provider Demographics
NPI:1528086741
Name:WILKINS, TALMADGE DEWITT IV (DMD)
Entity type:Individual
Prefix:DR
First Name:TALMADGE
Middle Name:DEWITT
Last Name:WILKINS
Suffix:IV
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:886 DAHLIA LN
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-4914
Mailing Address - Country:US
Mailing Address - Phone:722-567-2237
Mailing Address - Fax:772-567-1052
Practice Address - Street 1:886 DAHLIA LN
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-4914
Practice Address - Country:US
Practice Address - Phone:772-567-2237
Practice Address - Fax:772-567-1052
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0132971223G0001X
332B00000X
FLDN302111223G0001X
SC4035122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA477870058BMedicaid
SCZG3297Medicaid