Provider Demographics
NPI:1386765667
Name:WILKIE, RALPH FORBES JR (DDS)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:FORBES
Last Name:WILKIE
Suffix:JR
Gender:M
Credentials:DDS
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6405 TELEGRAPH
Mailing Address - Street 2:BLDG A
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-1716
Mailing Address - Country:US
Mailing Address - Phone:248-644-8787
Mailing Address - Fax:248-644-8789
Practice Address - Street 1:6405 TELEGRAPH
Practice Address - Street 2:BLDG A
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-1716
Practice Address - Country:US
Practice Address - Phone:248-644-8787
Practice Address - Fax:248-644-8789
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI2901011878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist