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General NPI Number Information
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NPI Number | 1013140672
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Entity Type | Individual
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Provider Name | ROBERT JAMES WILSON DDS
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Gender | Male
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 02/24/2010
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Provider Practice Location Address
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Address Line | 1321 N TENNESSEE ST # 108
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City | MCKINNEY
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State | TX
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Zip | 75069-2142
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Country | US
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Telephone | 469-742-0793
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 GRASSMERE LN APT 331
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City | MCKINNEY
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State | TX
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Zip | 75071-8519
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Country | US
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Telephone | 714-717-8910
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 58576
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25145
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License Number State | TX
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