Provider Demographics
NPI:1609949361
Name:WILSON, BARRY PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:PAUL
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 1:6299 NALL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202
Mailing Address - Country:US
Mailing Address - Phone:913-384-0044
Mailing Address - Fax:913-432-6635
Practice Address - Street 1:6299 NALL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202
Practice Address - Country:US
Practice Address - Phone:913-384-0044
Practice Address - Fax:913-432-6635
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS-64841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice