Provider Demographics
NPI:1386903813
Name:WILDER, ROBERT L (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:WILDER
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-9712
Mailing Address - Country:US
Mailing Address - Phone:509-891-7770
Mailing Address - Fax:509-891-7773
Practice Address - Street 1:210 S SULLIVAN RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-9712
Practice Address - Country:US
Practice Address - Phone:509-891-7770
Practice Address - Fax:098-917-7735
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3794122300000X
WA000075241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist