Provider Demographics
NPI:1770650244
Name:WILSON, RALPH F (DDS)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:F
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 1:7500 E PINNACLE PEAK RD
Mailing Address - Street 2:SUITE A200
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3406
Mailing Address - Country:US
Mailing Address - Phone:480-563-4145
Mailing Address - Fax:480-563-4194
Practice Address - Street 1:7500 E PINNACLE PEAK RD
Practice Address - Street 2:SUITE A200
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3406
Practice Address - Country:US
Practice Address - Phone:480-563-4145
Practice Address - Fax:480-563-4194
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56331223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics