Provider Demographics
NPI:1396828513
Name:WILSON, REX RALPH (DMD PC)
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:RALPH
Last Name:WILSON
Suffix:
Gender:M
Credentials:DMD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901
Mailing Address - Country:US
Mailing Address - Phone:256-943-9046
Mailing Address - Fax:
Practice Address - Street 1:522 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901
Practice Address - Country:US
Practice Address - Phone:256-943-9046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3982122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist