Provider Demographics
NPI:1003814393
Name:MORISHITA, WILSON S (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILSON
Middle Name:S
Last Name:MORISHITA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 LOCUST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-4457
Mailing Address - Country:US
Mailing Address - Phone:626-796-5361
Mailing Address - Fax:626-796-3857
Practice Address - Street 1:747 LOCUST ST STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-4457
Practice Address - Country:US
Practice Address - Phone:626-796-5361
Practice Address - Fax:626-796-3857
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243171223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics