Provider Demographics
NPI:1952318172
Name:WILSON, OLCIE LEE III (DMD)
Entity Type:Individual
Prefix:DR
First Name:OLCIE
Middle Name:LEE
Last Name:WILSON
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1930 ALCOA HWY
Mailing Address - Street 2:MEDICAL BLDG. A SUITE 340
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1500
Mailing Address - Country:US
Mailing Address - Phone:865-544-9440
Mailing Address - Fax:865-544-9442
Practice Address - Street 1:1930 ALCOA HWY
Practice Address - Street 2:MEDICAL BLDG. A SUITE 340
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1500
Practice Address - Country:US
Practice Address - Phone:865-544-9440
Practice Address - Fax:865-544-9442
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 00050471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice