Provider Demographics
NPI:1043207475
Name:WIKSTEN, DAVID VERNON (DDS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:VERNON
Last Name:WIKSTEN
Suffix:
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 1:5100 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2321
Mailing Address - Country:US
Mailing Address - Phone:785-273-8088
Mailing Address - Fax:785-273-4096
Practice Address - Street 1:5100 SW 28TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2321
Practice Address - Country:US
Practice Address - Phone:785-273-8088
Practice Address - Fax:785-273-4096
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist