Provider Demographics
NPI:1467834093
Name:MASSEY, WILSON MORRIS III (DDS)
Entity Type:Individual
Prefix:
First Name:WILSON
Middle Name:MORRIS
Last Name:MASSEY
Suffix:III
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 1:217 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-2812
Mailing Address - Country:US
Mailing Address - Phone:931-363-1564
Mailing Address - Fax:
Practice Address - Street 1:217 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-2812
Practice Address - Country:US
Practice Address - Phone:931-363-1564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN100851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice