Provider Demographics
NPI:1861571796
Name:ELICK, WILEY M (DDS)
Entity type:Individual
Prefix:MR
First Name:WILEY
Middle Name:M
Last Name:ELICK
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 1:7380 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245
Mailing Address - Country:US
Mailing Address - Phone:559-924-2412
Mailing Address - Fax:559-924-1931
Practice Address - Street 1:460 GREENFIELD AVE
Practice Address - Street 2:STE 9
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3500
Practice Address - Country:US
Practice Address - Phone:559-582-0238
Practice Address - Fax:559-582-1365
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOCS286122300000X
CA21245122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist