Individual
MR. JACK ANTHONY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RDHAP
Contact information
Practice address
2654 STACEY WAY, NATIONAL CITY, CA 91950-7760
(559) 289-8293
Mailing address
2654 STACEY WAY, NATIONAL CITY, CA 91950-7760
(559) 289-8293
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
HAP 299
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
299
REGISTERED DENTAL HYGIENIST IN ALTERNATIVE PRACTICE
CA
Enumeration date
06/24/2005
Last updated
07/15/2014
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us