Provider Demographics
NPI:1487799847
Name:WILSON, TIMOTHY TODD (DMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:TODD
Last Name:WILSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 WASHINGTON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-1207
Mailing Address - Country:US
Mailing Address - Phone:412-833-1133
Mailing Address - Fax:412-835-5000
Practice Address - Street 1:1725 WASHINGTON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-1207
Practice Address - Country:US
Practice Address - Phone:412-833-1133
Practice Address - Fax:412-835-5000
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024162-L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA449907OtherUNITED CONCORDIA
WI9178297OtherDORAL DENTAL INSURANCE
PA24162PAOtherDELTA DENTAL OF PA