Healthcare Provider Details

I. General information

NPI: 1992622427
Provider Name (Legal Business Name): COLTON WILSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 WORTHINGTON BLVD STE A
FREDERICK MD
21704-7020
US

IV. Provider business mailing address

3401 TUDOR DR
ADAMSTOWN MD
21710-9432
US

V. Phone/Fax

Practice location:
  • Phone: 301-874-6350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18796
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: