Healthcare Provider Details

I. General information

NPI: 1831542265
Provider Name (Legal Business Name): JOSHUA WILSON D.D.S., M.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 HATCHER LN
COLUMBIA TN
38401-3524
US

IV. Provider business mailing address

806 HATCHER LN
COLUMBIA TN
38401-3524
US

V. Phone/Fax

Practice location:
  • Phone: 931-381-2700
  • Fax: 931-381-2596
Mailing address:
  • Phone: 931-381-2700
  • Fax: 931-381-2596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10000
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: