person
Dr. Justin Richard Wild, DDS
Student in an Organized Health Care Education/Training Program in Bloomington, Minnesota
NPI 1043500648

Justin Richard Wild is a Student in an Organized Health Care Education/Training Program based in Bloomington, MN. Justin Richard Wild practices in Bloomington, MN and has the professional credentials of DDS. The NPI Number for Justin Richard Wild is 1043500648 and holds a License No. (Minnesota).

The current practice location address for Justin Richard Wild is 9651 Wyoming Ter S, Bloomington, MN and can be reached out via phone at 952-237-8619.

Location: 9651 Wyoming Ter S, Bloomington, MN, 55438-1606
person
Provider Profile Details
NPI Number
1043500648
Provider Name
Justin Richard Wild
Credential
DDS
Provider Entity Type
Individual
Gender
Male
Address
9651 Wyoming Ter S, Bloomington, MN, 55438-1606
Phone Number
952-237-8619
Fax Number
Provider Enumeration Date
04/15/2011
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
9651 Wyoming Ter S
City
State
Zip
55438-1606
Phone Number
952-237-8619
Fax Number
person
Provider Business Mailing Address Details
Address
9651 Wyoming Ter S
City
State
Zip
55438-1606
Phone Number
952-237-8619
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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