Anthony, Larry Wilson

Anthony, Larry Wilson is an sole proprietor health care provider with primary practice located at 2953 Broad Ave , Memphis TN 38112-2957. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / General Practice. Dental Providers / General Practice is his primary health care specialty. Anthony, Larry Wilson can be contacted via phone (901) 271-6050.

Contact Information

Primary practice address
2953 Broad Ave Memphis TN 38112-2957
Phone: (901) 271-6050
Fax: (901) 271-0699
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X DN014026 Georgia
Dental Providers / General Practice 1223G0001X 9470 Tennessee

Profile Details

NPI number 1801128582
LBN Legal business name Anthony, Larry Wilson
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 5th, 2010
Last updated Sep 27th, 2013 - about 13 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 1801128582 NPPES
Tennessee MEDICAID Q001343

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