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General NPI Number Information
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NPI Number | 1568674380
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Entity Type | Individual
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Provider Name | MATTHEW T WILSON DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 86 MDG, UNIT 3215, RAMSTEIN AB
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City | APO
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State | AE
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Zip | 09094
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Country | US
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Telephone | 240-612-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 86 MDG, UNIT 3215, RAMSTEIN AB
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City | APO
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State | AE
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Zip | 09094
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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 |
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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 | 16745
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | D0090793
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 16745
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License Number State | MD
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