Provider Demographics
NPI:1548320963
Name:WILKINSON, MICHAEL S (DMD, MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:WILKINSON
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Gender:M
Credentials:DMD, MD
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Other - Credentials:
Mailing Address - Street 1:1320 N 600 E
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2431
Mailing Address - Country:US
Mailing Address - Phone:435-752-5681
Mailing Address - Fax:435-752-5744
Practice Address - Street 1:1320 N 600 E
Practice Address - Street 2:SUITE 3
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2431
Practice Address - Country:US
Practice Address - Phone:435-752-5681
Practice Address - Fax:435-752-5744
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2012-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT7954579-9924204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery