Provider Demographics
NPI:1922778505
Name:MATTHEW J WILSON INSPIRE DENTAL LLC
Entity Type:Organization
Organization Name:MATTHEW J WILSON INSPIRE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-309-0909
Mailing Address - Street 1:2095 VILLAGE CENTER CIR STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6253
Mailing Address - Country:US
Mailing Address - Phone:702-309-0909
Mailing Address - Fax:
Practice Address - Street 1:2095 VILLAGE CENTER CIR STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-6253
Practice Address - Country:US
Practice Address - Phone:702-309-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty