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General NPI Number Information
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NPI Number | 1073101093
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Entity Type | Organization
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Legal Business Name | KRISTEN H FRITZ DDS MS AND M CLIFF WILSON DDS MS
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Dates
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Enumeration Date | 01/05/2021
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 363 VILLAGE WALK DR
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-7684
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Country | US
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Telephone | 919-285-4481
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Fax |
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Provider Business Mailing Address
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Address Line | 363 VILLAGE WALK DR
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-7684
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Country | US
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Telephone | 919-285-4481
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Fax |
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Authorized Official
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Title or Position | CO-PRESIDENT/OWNER
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Name | DR. MICHAEL CLIFF WILSON
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Credential | DDS, MS
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Telephone | 919-222-1615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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