Provider Demographics
NPI:1659360261
Name:WILSON, DON ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:ALLEN
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 1:1432 SPARTA ST
Mailing Address - Street 2:
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1302
Mailing Address - Country:US
Mailing Address - Phone:931-473-9595
Mailing Address - Fax:931-473-0592
Practice Address - Street 1:1432 SPARTA ST
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1302
Practice Address - Country:US
Practice Address - Phone:931-473-9595
Practice Address - Fax:931-473-0592
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS22401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice