Organization
WILSON DENTAL CLINIC, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE ALAN WILSON D.D.S. (DENTIST)
(641) 585-5431
Entity
Organization
Contact information
Practice address
145 N CLARK ST, FOREST CITY, IA 50436-1615
(641) 585-5431
(641) 585-5435
Mailing address
145 N CLARK ST, FOREST CITY, IA 50436-1615
(641) 585-5431
(641) 585-5435
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5660
IA
1223G0001X
General Practice Dentistry
7842
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0119651
—
IA
05
—
0253963
—
IA
01
—
11965
BC/BS OF IA FEDERAL PROGR
IA
01
—
48855
BC/BS OF IA FEDERAL PROGR
IA
Enumeration date
10/26/2006
Last updated
08/22/2020
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