Provider Demographics
NPI:1174997142
Name:WIKLE DENTISTRY LLC
Entity type:Organization
Organization Name:WIKLE DENTISTRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT/MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WIKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-726-8295
Mailing Address - Street 1:3900 DOUGLAS WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3446
Mailing Address - Country:US
Mailing Address - Phone:503-636-8446
Mailing Address - Fax:503-636-4446
Practice Address - Street 1:3900 DOUGLAS WAY
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3446
Practice Address - Country:US
Practice Address - Phone:503-636-8446
Practice Address - Fax:503-636-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD95751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty