Healthcare Provider Details

I. General information

NPI: 1619274784
Provider Name (Legal Business Name): WILLIAM F WILBERT DPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 S CHURCH ST
MURFREESBORO TN
37127-5508
US

IV. Provider business mailing address

5950 PETTUS RD
ANTIOCH TN
37013-4517
US

V. Phone/Fax

Practice location:
  • Phone: 615-867-9001
  • Fax:
Mailing address:
  • Phone: 615-941-1038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3083
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: