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General NPI Number Information
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NPI Number | 1477636280
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Entity Type | Organization
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Legal Business Name | SHAWN K WILSON DDS INC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 3110 CHURN CREEK ROAD
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City | REDDING
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State | CA
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Zip | 96002
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Country | US
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Telephone | 530-222-0515
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Fax | 530-222-1623
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Provider Business Mailing Address
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Address Line | 3110 CHURN CREEK ROAD SUITE A
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City | REDDING
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State | CA
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Zip | 96002
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Country | US
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Telephone | 530-222-0515
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Fax | 530-222-1623
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | DR. SHAWN KEVIN WILSON
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Credential | DDS
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Telephone | 530-222-0515
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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 | 032518
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License Number State | CA
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