| Doctor Name: | MR. JACK ANTHONY WILSON |
| NPI Number: | 1043216807 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RDHAP |
| License Number: | HAP 299 |
| Business Practice Address: | 2654 Stacey Way National City, CA - 919507760 |
| Business Phone Number: | 5592898293 |
| Business Fax Number: | |
| Mailing Address: | 2654 Stacey Way, NATIONAL CITY |
| State: | CA |
| Postal Code: | 919507760 |
| Phone Number: | 5592898293 |
| Fax Number: | |
| NPI Enumeration Date: | 06/24/2005 |
| NPI Last Update Date: | 07/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 124Q00000X |
| License Number: | HAP 299 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dental Hygienist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental examiners to provide preventive care services under the supervision of a dentist. Functions that may be legally delegated to the dental hygienist vary based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations, but always include, at a minimum, scaling and polishing the teeth. To avoid misleading the public, no occupational title other than dental hygienist should be used to describe this dental auxiliary. |