DR. Lewis Clark Wilde, DDS

NPI #1922673599 in Gallup, New Mexico

Provider Information

NPI Number: 1922673599
Entity Type: Individual
Name: DR. Lewis Clark Wilde, DDS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DDS
Enumeration Date: May 25, 2021
Last Updated: Jul 6, 2021

Practice Location

Address: 1601 S SECOND ST
City: Gallup
State: New Mexico
ZIP Code: 87301-5816
Phone: (505) 722-4422

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary
Student in an Organized Health Care Education/Training Program	390200000X

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