Wilson, Mark Edward

Wilson, Mark Edward is an individual health care provider with primary practice located at 4605 Fairway Ave , North Little Rock AR 72116. He recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as his primary health care specialty. Wilson, Mark Edward can be contacted via phone (501) 771-2990.

Contact Information

Primary practice address
4605 Fairway Ave North Little Rock AR 72116
Phone: (501) 771-2990
Fax: (501) 753-0408
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X 2817 Arkansas

Profile Details

NPI number 1912924424
LBN Legal business name Wilson, Mark Edward
Credentials DDS MS
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 17th, 2006
Last updated Jul 8th, 2007 - about 18 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 1912924424 NPPES
Arkansas Other 58323 BLUECROSS BLUESHIELD
Arkansas MEDICAID 115618608 BLUECROSS BLUESHIELD

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