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General NPI Number Information
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NPI Number | 1114299047
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Entity Type | Organization
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Legal Business Name | CAROL A. WILSON, DMD, PLLC
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 100 LAKE ST
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-1002
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Country | US
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Telephone | 859-885-5703
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Fax | 859-885-5703
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Provider Business Mailing Address
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Address Line | 100 LAKE ST
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-1002
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Country | US
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Telephone | 859-885-5703
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Fax | 859-885-5703
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. CAROL ANN WILSON
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Credential | DMD
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Telephone | 859-885-5703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8377
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8377
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License Number State | KY
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