Provider Demographics
NPI:1063574325
Name:WILSON, REBECCA MAY (DDS)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MAY
Last Name:WILSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24815 US HIGHWAY 281 N STE 111
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2629
Mailing Address - Country:US
Mailing Address - Phone:210-742-7200
Mailing Address - Fax:210-742-2888
Practice Address - Street 1:24815 US HIGHWAY 281 N STE 111
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-742-7200
Practice Address - Fax:210-742-2888
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111244304Medicaid