Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 7954579-9924 | UT |
NPI | 1548320963 |
---|---|
Provider Name | Michael S Wilkinson |
First Address | Logan, UT 84341-2431 |
Second Address | Logan, UT 84341-2431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 01/10/2012 |