Provider Demographics
NPI:1366679631
Name:WILSON, ROBERT CLYDE III (DDS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CLYDE
Last Name:WILSON
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6759 WELL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SINGERS GLEN
Mailing Address - State:VA
Mailing Address - Zip Code:22850-2524
Mailing Address - Country:US
Mailing Address - Phone:540-833-4036
Mailing Address - Fax:540-943-7505
Practice Address - Street 1:437 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3607
Practice Address - Country:US
Practice Address - Phone:540-943-7077
Practice Address - Fax:540-943-7505
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014124571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice