# DR J BRAD WILSON & DR KIM BADELL WILSON INC

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

## Provider details

- **NPI number:** 1750576633
- **Authorized official:** DR. J BRAD WILSON DDS (OWNER)
- **Authorized official phone:** (812) 482-1855

## Contact information

- **Practice address:** 288 NORTHWOOD AVE, JASPER, IN 47546-1212
- **Practice address phone:** (812) 482-1855
- **Practice address fax:** (812) 634-6833
- **Mailing address:** 288 NORTHWOOD AVE, JASPER, IN 47546-1212
- **Mailing address phone:** (812) 482-1855
- **Mailing address fax:** (812) 634-6833

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 8244 | IN | Yes |

## Other

- **Enumeration date:** 09/13/2007
- **Last updated:** 09/13/2007