Individual
DR. GREGORY L WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
710 FEDERAL DRIVE, SELMER, TN 38375
(731) 645-7506
(731) 645-5660
Mailing address
710 FEDERAL DRIVE, SELMER, TN 38375
(731) 645-7506
(731) 645-5660
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS3832
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0106853
BLUE CROSS BLUE SHIELD
TN
05
—
3226180
—
TN
01
—
792419
UNITED CONCORDIA
—
Enumeration date
02/27/2007
Last updated
11/30/2012
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