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General NPI Number Information
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NPI Number | 1184006074
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Entity Type | Organization
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Legal Business Name | JOHN WILSON DDS, PLLC
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 2005 PINE ST
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City | SANDPOINT
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State | ID
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Zip | 83864-9327
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Country | US
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Telephone | 509-949-8147
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 PINE ST
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City | SANDPOINT
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State | ID
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Zip | 83864-9327
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN WILSON
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Credential |
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Telephone | 208-263-8535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D-4649
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License Number State | ID
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