Wilson, Jack Anthony

Wilson, Jack Anthony is an sole proprietor health care provider with primary practice located at 2654 Stacey Way , National City CA 91950-7760. He recently has only one registered license in Dental Providers / Dental Hygienist, which is considered as his primary health care specialty. Wilson, Jack Anthony can be contacted via phone (559) 289-8293.

Contact Information

Primary practice address
2654 Stacey Way National City CA 91950-7760
Phone: (559) 289-8293
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dental Hygienist 124Q00000X HAP 299 California

Profile Details

NPI number 1043216807
LBN Legal business name Wilson, Jack Anthony
Credentials RDHAP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 24th, 2005
Last updated Jul 15th, 2014 - about 12 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 1043216807 NPPES
California Other 299 REGISTERED DENTAL HYGIENIST IN ALTERNATIVE PRACTICE

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