MEDICARE: DR. RYNE PATRICK WILSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223D0004X	Dental Anesthesiology	31333	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811363807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYNE PATRICK WILSON DDS

Provider Business Mailing Address
First Line	:	8603 FOREST HILLS BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-4024
Country	:	US
Telephone Number	:	432-352-1305
Fax Number	:

Provider Business Practice Location Address
First Line	:	8603 FOREST HILLS BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-4024
Country	:	US
Telephone Number	:	432-352-1305
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	06/16/2022

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