Provider Demographics
NPI:1528171675
Name:WILK, ARTHUR EDWARD JR (DDS)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:EDWARD
Last Name:WILK
Suffix:JR
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 1:34 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413
Mailing Address - Country:US
Mailing Address - Phone:860-669-3219
Mailing Address - Fax:860-669-3258
Practice Address - Street 1:34 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413
Practice Address - Country:US
Practice Address - Phone:860-669-3219
Practice Address - Fax:860-669-3258
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT64991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002064997Medicaid
CT002064997Medicaid
190000815Medicare ID - Type Unspecified