Individual
DR. WILLIAM T WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
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
BLUE CROSS BLUE SHIELD
AL
01
—
1906760
UNITED CONCORDIA
AL
Enumeration date
07/07/2006
Last updated
07/08/2007
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