Provider Demographics
NPI:1154408441
Name:WILDEN, WILLIAM M (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:WILDEN
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 1:8901 E TRENT AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2333
Mailing Address - Country:US
Mailing Address - Phone:509-928-6800
Mailing Address - Fax:
Practice Address - Street 1:8901 E TRENT AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2333
Practice Address - Country:US
Practice Address - Phone:509-928-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6639122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist