Provider Demographics
NPI:1437250560
Name:WILSON, JOSEPH ROSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROSS
Last Name:WILSON
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 1:2999 CORPORATE LANE, SUITE B-9
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434
Mailing Address - Country:US
Mailing Address - Phone:757-922-8110
Mailing Address - Fax:757-922-8184
Practice Address - Street 1:2999 CORPORATE LANE, SUITE B-9
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434
Practice Address - Country:US
Practice Address - Phone:757-922-8110
Practice Address - Fax:757-922-8184
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412222122300000X, 1223P0221X
MND123071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice