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Organization
WILSON DENTAL PC
Active
Organization
WILSON DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC THOMAS WILSON DDS (OWNER/PRESIDENT)
(276) 228-8571
Entity
Organization
Contact information
Practice address
205 COMMUNITY BLVD, WYTHEVILLE, VA 24382-2659
(276) 228-8571
(276) 228-8571
Mailing address
205 COMMUNITY BLVD, WYTHEVILLE, VA 24382-2659
(276) 228-8571
(276) 228-8571
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401414802
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285014019
PERSONAL NPI
—
Enumeration date
02/22/2018
Last updated
09/25/2024
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