Individual
NICHOLAS A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
5615 ROUTE 8, GIBSONIA, PA 15044-9553
(724) 444-4777
Mailing address
9819 PRESIDENTIAL DR, APT 203, ALLISON PARK, PA 15101-1886
(412) 369-4494
(724) 598-7337
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS026616L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001176288
—
PA
05
—
0011762880012
—
PA
05
—
0011762880022
—
PA
05
—
0011762880034
—
PA
05
—
2241434
—
OH
Enumeration date
11/22/2005
Last updated
08/16/2019
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