Provider Demographics
NPI:1770584401
Name:WILSON, WILLIAM ORVILLE JR (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ORVILLE
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8901 WISCONSIN AVE.
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-0001
Mailing Address - Country:US
Mailing Address - Phone:301-319-4653
Mailing Address - Fax:301-295-5767
Practice Address - Street 1:8901 WISCONSIN AVE.
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-319-4653
Practice Address - Fax:301-295-5767
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV34661223P0700X
VA04014143811223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics