Provider Demographics
NPI:1750452249
Name:WILSON, BRYAN JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JEFFREY
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 1:2172 ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-4937
Mailing Address - Country:US
Mailing Address - Phone:530-534-1663
Mailing Address - Fax:
Practice Address - Street 1:2172 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-4937
Practice Address - Country:US
Practice Address - Phone:530-534-1663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice