# JOHN WILSON DDS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pine Street Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184006074
- **Authorized official:** JOHN WILSON (OWNER)
- **Authorized official phone:** (208) 263-8535

## Contact information

- **Practice address:** 2005 PINE ST, SANDPOINT, ID 83864-9327
- **Practice address phone:** (509) 949-8147
- **Mailing address:** 2005 PINE ST, SANDPOINT, ID 83864-9327

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D-4649 | ID | Yes |

## Other

- **Enumeration date:** 06/26/2015
- **Last updated:** 09/19/2025