Healthcare Provider Details

I. General information

NPI: 1649298944
Provider Name (Legal Business Name): THOMAS BENEDICT WILSON I DDS,MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 DEARFIELD DR STE G-1
GREENWICH CT
06831-5351
US

IV. Provider business mailing address

4 DEARFIELD DR STE G-1
GREENWICH CT
06831-5351
US

V. Phone/Fax

Practice location:
  • Phone: 203-661-5858
  • Fax:
Mailing address:
  • Phone: 203-661-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number049719-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: