Provider Demographics
NPI:1265449813
Name:WILSON, ANDREW THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:THOMAS
Last Name:WILSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 COLD SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-2713
Mailing Address - Country:US
Mailing Address - Phone:814-643-7300
Mailing Address - Fax:814-643-7300
Practice Address - Street 1:3195 COLD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-2713
Practice Address - Country:US
Practice Address - Phone:814-643-7300
Practice Address - Fax:814-643-7300
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030745L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1523344OtherUNITED CONCORDIA