# BRUCE T. WILSON,D.M.D., PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396924544
- **Authorized official:** DR. BRUCE TAYLOR WILSON DMD (PRESIDENT)
- **Authorized official phone:** (606) 248-1808

## Contact information

- **Practice address:** 123 N 19TH ST, MIDDLESBORO, KY 40965-2865
- **Practice address phone:** (606) 248-1808
- **Practice address fax:** (606) 248-1803
- **Mailing address:** 123 N 19TH ST, PO BOX 1786, MIDDLESBORO, KY 40965-2865
- **Mailing address phone:** (606) 248-1808
- **Mailing address fax:** (606) 248-1803

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 5811 | KY | Yes |

## Other

- **Enumeration date:** 10/24/2007
- **Last updated:** 10/24/2007