Provider Demographics
NPI:1831542265
Name:WILSON, JOSHUA (DDS, MDS)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 HATCHER LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3524
Mailing Address - Country:US
Mailing Address - Phone:931-381-2700
Mailing Address - Fax:931-381-2596
Practice Address - Street 1:806 HATCHER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3524
Practice Address - Country:US
Practice Address - Phone:931-381-2700
Practice Address - Fax:931-381-2596
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN100001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics