# DR. GREG L. WILSON FAMILY DENTISTRY

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

## Provider details

- **NPI number:** 1689836132
- **Authorized official:** CHRISTINA L KING (INSURANCE COORDINATOR)
- **Authorized official phone:** (731) 645-7506

## Contact information

- **Practice address:** 710 FEDERAL DR, SELMER, TN 38375-1876
- **Practice address phone:** (731) 645-7506
- **Practice address fax:** (731) 645-5660
- **Mailing address:** 710 FEDERAL DR, SELMER, TN 38375-1876
- **Mailing address phone:** (731) 645-7506
- **Mailing address fax:** (731) 645-5660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 3832 | TN | Yes |
| 1223G0001X | General Practice Dentistry | 8695 | TN | — |

## Other

- **Enumeration date:** 06/26/2008
- **Last updated:** 06/26/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 003729 | DORAL DENTAL | TN |
| 01 | — | 0106853 | BC/BS OF TENNESSEE | TN |
| 01 | — | 792419 | UNITED CONCORDIA | — |