David G Wilson Dmd LLC
Dentist in Selinsgrove, PA. Organization (NPI-2).
NPI number1154773489
StatusActive
Last updated in NPPESOct 20, 2016
Details
- NPI
- 1154773489
- Entity type
- Organization (NPI-2)
- Legal business name
- David G Wilson Dmd LLC
- Organization subpart
- Yes
- Enumeration date
- Jul 11, 2016
- Last updated
- Oct 20, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | DS019605L | PA | Yes |
| 332BC3200X | Durable Medical Equipment & Medical Supplies, Customized Equipment | – | – |
Other names
- Wilson Orthodontics (Doing Business As)
Practice location
1372 N Susquehanna Trl Ste 140Selinsgrove, PA 17870-8973
Phone 570-743-8119 · Fax 570-743-2009
Mailing address
1372 N Susquehanna Trl Ste 140Selinsgrove, PA 17870-8973
Phone 570-743-8119 · Fax 570-743-2009
Authorized official
David G Wilson
Owner/Orthodontist
5708508119
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