Provider Demographics
NPI:1669452595
Name:WILSON, THOMAS KING (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KING
Last Name:WILSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S SANTA FE AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4190
Mailing Address - Country:US
Mailing Address - Phone:785-827-9325
Mailing Address - Fax:785-827-6252
Practice Address - Street 1:520 S SANTA FE AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4190
Practice Address - Country:US
Practice Address - Phone:785-827-9325
Practice Address - Fax:785-827-6252
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS57191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery