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General NPI Number Information
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NPI Number | 1609076025
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Entity Type | Individual
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Provider Name | PHILIP MICHAEL WILSON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 690 SW HIGGINS AVE STE H
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City | MISSOULA
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State | MT
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Zip | 59803-1433
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Country | US
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Telephone | 406-543-3159
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 COONEY RIDGE RD
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City | FLORENCE
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State | MT
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Zip | 59833-6677
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Country | US
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Telephone | 936-615-1792
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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 | 27341
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License Number State | MT
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