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General NPI Number Information
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NPI Number | 1609360478
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Entity Type | Individual
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Provider Name | PETER JOHN WILSON DMD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2018
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 1 INN ST
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City | NEWBURYPORT
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State | MA
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Zip | 01950-2557
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Country | US
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Telephone | 978-992-3550
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Fax |
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Provider Business Mailing Address
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Address Line | 4 PORTLAND AVE APT 3
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City | DOVER
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State | NH
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Zip | 03820-6508
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Country | US
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Telephone | 330-780-9747
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 04422
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1858772
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License Number State | MA
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