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General NPI Number Information
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NPI Number | 1780759647
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Entity Type | Individual
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Provider Name | ROBERT JAMES WILSON JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9 DESELLUM AVE
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City | GAITHERSBURG
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State | MD
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Zip | 20877
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Country | US
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Telephone | 301-926-1511
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Fax | 301-948-3553
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Provider Business Mailing Address
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Address Line | 9 DESELLUM AVE
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City | GAITHERSBURG
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State | MD
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Zip | 28877
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Country | US
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Telephone | 301-926-1511
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Fax | 301-948-3553
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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 | 09129
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License Number State | MD
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