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General NPI Number Information
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NPI Number | 1538971957
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Entity Type | Organization
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Legal Business Name | MATTHEW WILSON DMD LLC
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 11254 COUNTY LINE RD STE B
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City | MADISON
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State | AL
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Zip | 35756-2024
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Country | US
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Telephone | 256-289-8010
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Fax | 256-289-8011
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Provider Business Mailing Address
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Address Line | 11254 COUNTY LINE RD STE B
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City | MADISON
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State | AL
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Zip | 35756-2024
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Country | US
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Telephone | 256-289-8010
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Fax | 256-289-8011
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Authorized Official
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Title or Position | OWNER - DENTIST
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Name | DR. MATTHEW WILSON
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Credential | DMD
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Telephone | 256-655-4766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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