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General NPI Number Information
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NPI Number | 1629142690
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Entity Type | Individual
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Provider Name | DAVID WILLIAM WILSON DMD
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2862 FARRELL CRES
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City | OWENSBORO
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State | KY
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Zip | 42303-1392
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Country | US
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Telephone | 270-684-3610
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Fax | 270-684-3914
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Provider Business Mailing Address
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Address Line | 2862 FARRELL CRES
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City | OWENSBORO
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State | KY
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Zip | 42303-1392
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Country | US
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Telephone | 270-684-3610
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Fax | 270-684-3914
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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 | 5996
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License Number State | KY
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