Provider Demographics
NPI:1962635870
Name:WILSON, JOHN CHESLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHESLEY
Last Name:WILSON
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:2325 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4600
Mailing Address - Country:US
Mailing Address - Phone:812-944-9300
Mailing Address - Fax:812-948-0547
Practice Address - Street 1:2325 GREEN VALLEY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4600
Practice Address - Country:US
Practice Address - Phone:812-944-9300
Practice Address - Fax:812-948-0547
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2014-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY88131223G0001X
KY89851223P0221X
IN12011910A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice