Provider Demographics
NPI:1780647388
Name:WILSON, JOHN HINTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HINTON
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:BUREAU OF MEDICINE AND SURGERY DETACHMENT JACKSONVILLE
Mailing Address - Street 2:BUILDING 554
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32212-0140
Mailing Address - Country:US
Mailing Address - Phone:877-772-4373
Mailing Address - Fax:
Practice Address - Street 1:BUREAU OF MEDICINE AND SURGERY DETACHMENT JACKSONVILLE
Practice Address - Street 2:BUILDING 554
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-0140
Practice Address - Country:US
Practice Address - Phone:877-772-4373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12047122300000X
GADN0120471223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist