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General NPI Number Information
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NPI Number | 1932494127
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Entity Type | Individual
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Provider Name | JOHN C WILSON DMD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 2675 CENTRAL AVE STE L8
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City | BILLINGS
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State | MT
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Zip | 59102-6686
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Country | US
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Telephone | 406-294-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 4331 HUCKLEBERRY LN S
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City | BILLINGS
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State | MT
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Zip | 59106-1504
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Country | US
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Telephone | 801-921-3603
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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 | 7999864-8903
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN-DEN-LIC-11558
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License Number State | MT
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