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General NPI Number Information
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NPI Number | 1336352236
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Entity Type | Individual
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Provider Name | LOIS S WILSON D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 11/09/2018
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Provider Practice Location Address
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Address Line | 1447 DOLLEY MADISON BLVD STE C
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City | MC LEAN
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State | VA
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Zip | 22101-6041
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Country | US
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Telephone | 703-457-1147
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Fax | 703-884-1504
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Provider Business Mailing Address
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Address Line | 25 OAKDALE CT
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City | STERLING
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State | VA
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Zip | 20165-5642
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Country | US
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Telephone | 703-919-2506
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Fax | 703-406-9514
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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 | 16168
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8615
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License Number State | VA
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