Healthcare Provider Details

I. General information

NPI: 1316229313
Provider Name (Legal Business Name): JENNIFER JOANN WILSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER JOANN DARDEN DDS

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 08/14/2023
Certification Date: 08/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5098 BROWN STATION RD # 260
UPPER MARLBORO MD
20772-9124
US

IV. Provider business mailing address

5098 BROWN STATION RD # 260
UPPER MARLBORO MD
20772-9124
US

V. Phone/Fax

Practice location:
  • Phone: 240-326-3738
  • Fax: 240-545-5500
Mailing address:
  • Phone: 301-257-6452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number15073
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: