Organization
WILSON DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGG ANDREW WILSON DDS (DENTIST/CEO)
(208) 906-0501
Entity
Organization
Contact information
Practice address
10497 W GARVERDALE CT STE 107, BOISE, ID 83704-5468
(208) 375-5720
(208) 323-8538
Mailing address
10497 W GARVERDALE CT STE 107, BOISE, ID 83704-5468
(208) 375-5720
(208) 323-8538
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D35345
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807297400
—
ID
Enumeration date
03/08/2018
Last updated
03/08/2018
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