Individual
DR. BRUCE TAYLOR WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
705 N 12TH ST, MIDDLESBORO, KY 40965-1987
(606) 248-1808
(859) 823-4137
Mailing address
PO BOX 1786, MIDDLESBORO, KY 40965-3786
(606) 248-1808
(606) 248-1803
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5811
KY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
5811
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60058112
—
KY
05
—
64058118
—
KY
Enumeration date
05/19/2006
Last updated
08/15/2024
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