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Contact Information

CLARENCE J WILSON JR DDS INC
109 E 5TH ST
CARUTHERSVILLE, MO63830
 Phone: 573-333-1550
 Fax: 573-333-0055
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for CLARENCE J WILSON JR DDS INC

NPI # 1780760058
LBN Legal business name CLARENCE J WILSON JR DDS INC
Authorized official CLARENCE WILSON - (OWNER PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 10/31/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
MO License # 13167
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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