Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shane A Wilson

Individual provider Dentist · NPI 1780334664

Shane A Wilson is a Dentist in Gravois Mills, Missouri. Licensed in Missouri. Registered with an NPI since 2022.

Licensed in
MO
In the registry since
2022
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Practice location Address checks out

110 Watson Cir
Gravois Mills, MO 65037-4625
Phone: (763) 528-5539
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 2022019208 (MO)

Record details

NPI number1780334664
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 24, 2022
Last updated in NPPESJune 6, 2022
Certification dateJune 6, 2022
Mailing address110 Watson Cir, Gravois Mills, MO 65037-4625

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