# WILSON DENTAL LAB INC

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

## Provider details

- **NPI number:** 1568367712
- **Authorized official:** WILSON DUC PHAM CDT (OWNER)
- **Authorized official phone:** (249) 224-5335

## Contact information

- **Practice address:** 4500 47TH AVE STE 4, SACRAMENTO, CA 95824-3848
- **Practice address phone:** (916) 487-2236
- **Mailing address:** 4500 47TH AVE STE 4, SACRAMENTO, CA 95824-3848
- **Mailing address phone:** (916) 487-2236

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 292200000X | Dental Laboratory | — | NULL | Yes |

## Other

- **Enumeration date:** 10/08/2026
- **Last updated:** 10/08/2026