Provider Demographics
NPI:1861142275
Name:WILKINS, DAYLENE
Entity type:Individual
Prefix:
First Name:DAYLENE
Middle Name:
Last Name:WILKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAYLENE
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:707 US HIGHWAY 24 N
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-9863
Mailing Address - Country:US
Mailing Address - Phone:719-395-8610
Mailing Address - Fax:719-395-5745
Practice Address - Street 1:707 US HIGHWAY 24 N
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-9863
Practice Address - Country:US
Practice Address - Phone:719-395-8610
Practice Address - Fax:719-395-5745
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905555124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO905555OtherLICENSURE