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General NPI Number Information
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NPI Number | 1598638751
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Entity Type | Organization
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Legal Business Name | MICHAEL D. WILSON DDS INC
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Dates
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Enumeration Date | 09/24/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 12231 S EASTERN AVE STE 110
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City | HENDERSON
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State | NV
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Zip | 89052-4415
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Country | US
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Telephone | 702-791-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 12231 S EASTERN AVE STE 110
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City | HENDERSON
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State | NV
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Zip | 89052-4415
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Country | US
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Telephone | 702-791-3100
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL D. WILSON
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Credential | DDS
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Telephone | 702-334-2968
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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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