Provider Demographics
NPI:1124237268
Name:HILDRETH, J. WARREN JR (DDS)
Entity type:Individual
Prefix:
First Name:J.
Middle Name:WARREN
Last Name:HILDRETH
Suffix:JR
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 1:5566 MAEFIELD DR STE B
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-9109
Mailing Address - Country:US
Mailing Address - Phone:785-456-7083
Mailing Address - Fax:785-456-6520
Practice Address - Street 1:2046 N OLIVER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-2503
Practice Address - Country:US
Practice Address - Phone:316-681-2425
Practice Address - Fax:316-681-0947
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice