Provider Demographics
NPI:1336239086
Name:WILSON & FIQUETT, D.M.D., P.C.
Entity Type:Organization
Organization Name:WILSON & FIQUETT, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CLINTON
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-845-0765
Mailing Address - Street 1:110 23RD ST NW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-3671
Mailing Address - Country:US
Mailing Address - Phone:256-845-0765
Mailing Address - Fax:256-845-9895
Practice Address - Street 1:110 23RD ST NW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-3671
Practice Address - Country:US
Practice Address - Phone:256-845-0765
Practice Address - Fax:256-845-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty