Provider Demographics
NPI:1003367533
Name:CHRIS WILSON DDS, PLLC
Entity Type:Organization
Organization Name:CHRIS WILSON DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:432-682-0565
Mailing Address - Street 1:3000 N GARFIELD ST STE 185
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-6417
Mailing Address - Country:US
Mailing Address - Phone:432-682-0565
Mailing Address - Fax:432-682-9709
Practice Address - Street 1:3000 N GARFIELD ST STE 185
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-6417
Practice Address - Country:US
Practice Address - Phone:432-682-0565
Practice Address - Fax:432-682-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1801276654OtherNPI I
TX1831306141OtherNPI I