Wilson, Bernadette L

Wilson, Bernadette L is an individual health care provider with primary practice located at 430 Main St , Green Bay WI 54301-5115. She recently has 2 registered licenses in different health care specialties including Dental Providers / Oral and Maxillofacial Surgery, Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery. Dental Providers / Oral and Maxillofacial Surgery is her primary health care specialty. Wilson, Bernadette L can be contacted via phone (920) 431-0345.

Contact Information

Primary practice address
430 Main St Green Bay WI 54301-5115
Phone: (920) 431-0345
Fax: (920) 431-0567
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 2235 Montana
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X 11198 Montana
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X 5239 Wisconsin
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 5239 Wisconsin

Profile Details

NPI number 1861592529
LBN Legal business name Wilson, Bernadette L
Credentials DDS MD
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 23rd, 2006
Last updated Feb 6th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861592529 NPPES
Wisconsin MEDICAID 33761400

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