Provider Demographics
NPI:1336379056
Name:WILSON, JULIAN JEROME (DDS, FACS)
Entity type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:JEROME
Last Name:WILSON
Suffix:
Gender:M
Credentials:DDS, FACS
Other - Prefix:DR
Other - First Name:JULLIAN
Other - Middle Name:JEROME
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, FACS
Mailing Address - Street 1:3900 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2242
Mailing Address - Country:US
Mailing Address - Phone:925-219-6019
Mailing Address - Fax:
Practice Address - Street 1:1025 W AVENUE K
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-6428
Practice Address - Country:US
Practice Address - Phone:661-723-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA588861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery