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Organization
DAVID G WILSON DMD LLC
Active
Organization
DAVID G WILSON DMD LLC
Active
Parent organization
DAVID G WILSON DMD LLC
Other names
Wilson Orthodontics
Organization subpart
Yes
Provider details
NPI number
Legal business name
DAVID G WILSON DMD LLC
Authorized official
DR. DAVID G WILSON DMD (OWNER/ORTHODONTIST)
(570) 850-8119
Entity
Organization
Contact information
Practice address
1372 N SUSQUEHANNA TRL STE 140, SELINSGROVE, PA 17870-8973
(570) 743-8119
(570) 743-2009
Mailing address
1372 N SUSQUEHANNA TRL STE 140, SELINSGROVE, PA 17870-8973
(570) 743-8119
(570) 743-2009
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS019605L
PA
332BC3200X
Customized Equipment (DME)
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7556450001
MEDICARE DME PTAN NUMBER
PA
Enumeration date
07/11/2016
Last updated
10/20/2016
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