Doctor Name: | MR. GEORGE M. WILSON |
NPI Number: | 1124141536 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DDS |
License Number: | 24621 |
Business Practice Address: | 380 W Putnam Ave Porterville, CA - 932573323 |
Business Phone Number: | 5597819117 |
Business Fax Number: | 5597812819 |
Mailing Address: | 380 W Putnam Ave, PORTERVILLE |
State: | CA |
Postal Code: | 932573323 |
Phone Number: | 5597819117 |
Fax Number: | 5597812819 |
NPI Enumeration Date: | 04/09/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 24621 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |