Healthcare Provider Details

I. General information

NPI: 1154482297
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER WILSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 02/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 EISENHOWER DR
SAVANNAH GA
31406
US

IV. Provider business mailing address

501 EISENHOWER DR
SAVANNAH GA
31406
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-1515
  • Fax: 912-548-1813
Mailing address:
  • Phone: 912-354-1515
  • Fax: 912-548-1813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN013308
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: