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General NPI Number Information
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NPI Number | 1003367533
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Entity Type | Organization
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Legal Business Name | CHRIS WILSON DDS, PLLC
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 3000 N GARFIELD ST STE 185
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City | MIDLAND
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State | TX
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Zip | 79705-6417
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Country | US
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Telephone | 432-682-0565
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Fax | 432-682-9709
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Provider Business Mailing Address
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Address Line | 3000 N GARFIELD ST STE 185
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City | MIDLAND
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State | TX
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Zip | 79705-6417
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Country | US
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Telephone | 432-682-0565
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Fax | 432-682-9709
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Authorized Official
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Title or Position | MANAGER
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Name | CHRISTOPHER WILSON
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Credential | DDS
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Telephone | 432-682-0565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30926
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License Number State | TX
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