Provider Demographics
NPI:1306165378
Name:WILDEY, REX ELWYN (DDS)
Entity type:Individual
Prefix:
First Name:REX
Middle Name:ELWYN
Last Name:WILDEY
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 1:10003 NW MILITARY HWY
Mailing Address - Street 2:SUITE 3201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1885
Mailing Address - Country:US
Mailing Address - Phone:210-417-4181
Mailing Address - Fax:210-417-4181
Practice Address - Street 1:10003 NW MILITARY HWY
Practice Address - Street 2:SUITE 3201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231
Practice Address - Country:US
Practice Address - Phone:210-417-4181
Practice Address - Fax:210-417-4181
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25425122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist