Healthcare Provider Details

I. General information

NPI: 1255256921
Provider Name (Legal Business Name): EMILY WILSON DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 ROBERTSON ST
FORT COLLINS CO
80524-3926
US

IV. Provider business mailing address

1025 ROBERTSON ST
FORT COLLINS CO
80524-3926
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-4313
  • Fax:
Mailing address:
  • Phone: 970-493-4313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. EMILY GRACE RIESGRAF
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 651-399-3744