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General NPI Number Information
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NPI Number | 1912303561
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Entity Type | Organization
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Legal Business Name | RON D. WILSON DMD PC
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 1220 SHERWOOD PARK DRIVE
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City | GAINESVILLE
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State | GA
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Zip | 30501-3445
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Country | US
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Telephone | 770-536-0882
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 SHERWOOD PARK DRIVE
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City | GAINESVILLE
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State | GA
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Zip | 30501-3445
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Country | US
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Telephone |
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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. RON D WILSON
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Credential |
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Telephone | 770-536-0882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12912
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License Number State | GA
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