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General NPI Number Information
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NPI Number | 1295163913
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Entity Type | Individual
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Provider Name | WHITNEY WILSON DMD
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Gender | Female
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Dates
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Enumeration Date | 10/15/2013
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Last Update Date | 10/15/2013
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Provider Practice Location Address
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Address Line | 5110 MARYLAND WAY STE 190
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City | BRENTWOOD
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State | TN
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Zip | 37027-7508
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Country | US
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Telephone | 615-373-2030
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Fax | 615-373-7059
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Provider Business Mailing Address
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Address Line | 5110 MARYLAND WAY STE 190
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City | BRENTWOOD
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State | TN
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Zip | 37027-7508
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Country | US
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Telephone | 615-373-2030
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Fax | 615-373-7059
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9659
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License Number State | TN
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