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General NPI Number Information
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NPI Number | 1568367712
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Entity Type | Organization
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Legal Business Name | WILSON DENTAL LAB INC
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 4500 47TH AVE STE 4
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City | SACRAMENTO
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State | CA
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Zip | 95824-3848
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Country | US
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Telephone | 916-487-2236
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 47TH AVE STE 4
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City | SACRAMENTO
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State | CA
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Zip | 95824-3848
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Country | US
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Telephone | 916-487-2236
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILSON DUC PHAM
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Credential | CDT
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Telephone | 249-224-5335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number |
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License Number State | NULL
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