Healthcare Provider Details

I. General information

NPI: 1770650244
Provider Name (Legal Business Name): RALPH F. WILSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 E PINNACLE PEAK RD SUITE A200
SCOTTSDALE AZ
85255-3406
US

IV. Provider business mailing address

7500 E PINNACLE PEAK RD SUITE A200
SCOTTSDALE AZ
85255-3406
US

V. Phone/Fax

Practice location:
  • Phone: 480-563-4145
  • Fax: 480-563-4194
Mailing address:
  • Phone: 480-563-4145
  • Fax: 480-563-4194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number5633
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: