Wilson, Timothy A
Wilson, Timothy A is an sole proprietor health care provider with primary practice located at 169 N Nellis Blvd , Las Vegas NV 89110-5320. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / Pediatric Dentistry. Dental Providers / Pediatric Dentistry is his primary health care specialty. Wilson, Timothy A can be contacted via phone (702) 384-1010.Contact Information
Primary practice address
169 N Nellis Blvd
Las Vegas NV 89110-5320
Phone: (702) 384-1010
Fax: (702) 438-8424
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 4522T | Nevada |
| Dental Providers / Pediatric Dentistry | 1223P0221X | S6-142 | Nevada |
Profile Details
| NPI number | 1366582454 |
|---|---|
| LBN Legal business name | Wilson, Timothy A |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 7th, 2007 |
| Last updated | Jul 18th, 2016 - about 8 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366582454 | NPPES |
| Nevada | MEDICAID | 10052976 | |
| Nevada | MEDICAID | 1366582454 | |
| Nevada | MEDICAID | 100506669 |
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