Provider Demographics
NPI:1952094658
Name:BLISS WILSON FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:BLISS WILSON FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BLISS
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-850-1585
Mailing Address - Street 1:730 MEMORIAL DR STE 108
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-6084
Mailing Address - Country:US
Mailing Address - Phone:205-424-1450
Mailing Address - Fax:
Practice Address - Street 1:730 MEMORIAL DR STE 108
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-6084
Practice Address - Country:US
Practice Address - Phone:205-424-1450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty