Provider Demographics
NPI:1710194436
Name:PAES, WILKIE S (DDS)
Entity type:Individual
Prefix:DR
First Name:WILKIE
Middle Name:S
Last Name:PAES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 ROUTE 55
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12522
Mailing Address - Country:US
Mailing Address - Phone:845-486-4572
Mailing Address - Fax:845-559-0627
Practice Address - Street 1:1110 ROUTE 55
Practice Address - Street 2:SUITE 107
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12522
Practice Address - Country:US
Practice Address - Phone:845-486-4572
Practice Address - Fax:845-559-0627
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0529651223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice