Provider Demographics
NPI:1053027169
Name:WILKINS, DENTAIVA ANIYAH
Entity type:Individual
Prefix:
First Name:DENTAIVA
Middle Name:ANIYAH
Last Name:WILKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 SILVERBROOK W
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1021
Mailing Address - Country:US
Mailing Address - Phone:248-739-1116
Mailing Address - Fax:
Practice Address - Street 1:32100 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-2452
Practice Address - Country:US
Practice Address - Phone:248-739-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist