Provider Demographics
NPI:1780857094
Name:GAW, WILSON H (DDS)
Entity Type:Individual
Prefix:
First Name:WILSON
Middle Name:H
Last Name:GAW
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 1:2120 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1210
Mailing Address - Country:US
Mailing Address - Phone:713-861-7078
Mailing Address - Fax:713-861-8065
Practice Address - Street 1:2120 W 18TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1210
Practice Address - Country:US
Practice Address - Phone:713-861-7078
Practice Address - Fax:713-861-8065
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133271002Medicaid