Individual
DR. MARK EDWARD WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
4605 FAIRWAY AVE, NORTH LITTLE ROCK, AR 72116
(501) 771-2990
(501) 753-0408
Mailing address
4605 FAIRWAY AVE, NORTH LITTLE ROCK, AR 72116-8052
(501) 771-2990
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2817
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115618608
—
AR
01
—
58323
BLUECROSS BLUESHIELD
AR
Enumeration date
07/17/2006
Last updated
07/08/2007
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