Provider Demographics
NPI:1316122971
Name:WILEY, FRANK MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:MICHAEL
Last Name:WILEY
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 1:819 E MAIN
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-2715
Mailing Address - Country:US
Mailing Address - Phone:573-431-6021
Mailing Address - Fax:573-431-9621
Practice Address - Street 1:819 E MAIN
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-2715
Practice Address - Country:US
Practice Address - Phone:573-431-6021
Practice Address - Fax:573-431-9621
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO133671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice