Organization
DR. BRUCE T. WILSON D.D.S., PA
Active
Other names
Wilson Dental
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA MCCAIN (OFFICE MANAGER)
(870) 561-4400
Entity
Organization
Contact information
Practice address
3455 W STATE HIGHWAY 18, MANILA, AR 72442-8005
(870) 561-4400
(870) 561-4037
Mailing address
PO BOX 1345, MANILA, AR 72442-1345
(870) 561-4400
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180606608
—
AR
Enumeration date
01/07/2021
Last updated
01/07/2021
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