Organization
FAIRHOPE DENTAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM T WILSON DDS (MANAGER)
(251) 928-0620
Entity
Organization
Contact information
Practice address
108 PROFESSIONAL PARK DR, FAIRHOPE, AL 36532-1922
(251) 928-0620
(251) 928-1359
Mailing address
108 PROFESSIONAL PARK DR, FAIRHOPE, AL 36532-1922
(251) 928-0620
(251) 928-1359
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3466
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03142
BCBS
AL
01
—
1906760
UNITED CONCORDIA
AL
Enumeration date
07/22/2006
Last updated
08/22/2020
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