| Doctor Name: | DALTON PHILLIP WILSON |
| NPI Number: | 1144292814 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DENTIST |
| License Number: | 5037 |
| Business Practice Address: | 2501 Capehart Rd 55 Medical Group Offutt A F B, NE - 681131043 |
| Business Phone Number: | 4022329208 |
| Business Fax Number: | 4022949250 |
| Mailing Address: | 2501 Capehart Rd, 55 Medical Group OFFUTT A F B |
| State: | NE |
| Postal Code: | 681131043 |
| Phone Number: | 4022329208 |
| Fax Number: | 4022949250 |
| NPI Enumeration Date: | 02/06/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0700X |
| License Number: | 5037 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | TN |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Prosthodontics |
| Taxonomy Definition: | That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |