Provider Demographics
NPI:1962597971
Name:WILKINSON, GREGORY TODD (DDS)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:TODD
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5610 MURRAY RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119
Mailing Address - Country:US
Mailing Address - Phone:901-767-3390
Mailing Address - Fax:901-763-0465
Practice Address - Street 1:5610 MURRAY RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-767-3390
Practice Address - Fax:901-763-0465
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0070651223X0400X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics