Provider Demographics
NPI:1053329185
Name:WILSON, BRADLEY RIX (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:RIX
Last Name:WILSON
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2077 S GESSNER RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1147
Mailing Address - Country:US
Mailing Address - Phone:713-789-1200
Mailing Address - Fax:713-789-1219
Practice Address - Street 1:2077 S GESSNER RD
Practice Address - Street 2:SUITE 125
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1147
Practice Address - Country:US
Practice Address - Phone:713-789-1200
Practice Address - Fax:713-789-1219
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice