Provider Demographics
NPI:1043050941
Name:WILSON, WILLIAM BARRETT (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BARRETT
Last Name:WILSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 SPRINGBANK LN STE 150
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3361
Mailing Address - Country:US
Mailing Address - Phone:704-544-7330
Mailing Address - Fax:
Practice Address - Street 1:3135 SPRINGBANK LN STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3361
Practice Address - Country:US
Practice Address - Phone:704-544-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC136741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice