Provider Demographics
NPI:1508244294
Name:WILSON, JOSEPH W (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
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 1:27871 MEDICAL CENTER RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6404
Mailing Address - Country:US
Mailing Address - Phone:949-364-0770
Mailing Address - Fax:949-364-3526
Practice Address - Street 1:27871 MEDICAL CENTER RD
Practice Address - Street 2:SUITE 280
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6404
Practice Address - Country:US
Practice Address - Phone:949-364-0770
Practice Address - Fax:949-364-3526
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA351811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice