Provider Demographics
NPI:1689224495
Name:GRAHAM H. WILSON, DDS, PA
Entity Type:Organization
Organization Name:GRAHAM H. WILSON, DDS, PA
Other - Org Name:CONRAD AND WILSON ORAL AND MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-386-5003
Mailing Address - Street 1:7320 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9881
Mailing Address - Country:US
Mailing Address - Phone:910-386-5003
Mailing Address - Fax:910-681-1184
Practice Address - Street 1:7320 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9881
Practice Address - Country:US
Practice Address - Phone:910-386-5003
Practice Address - Fax:910-681-1184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty