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General NPI Number Information
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NPI Number | 1679658603
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Entity Type | Organization
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Legal Business Name | DEBORAH A WILSON DDS PA
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7130 MINSTREL WAY SUITE 210
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City | COLUMBIA
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State | MD
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Zip | 21045
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Country | US
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Telephone | 410-381-4701
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Fax | 410-381-2501
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Provider Business Mailing Address
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Address Line | 7130 MINSTREL WAY SUITE 210
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City | COLUMBIA
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State | MD
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Zip | 21045
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Country | US
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Telephone | 410-381-4701
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Fax | 410-381-2501
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEBORAH ARYANN WILSON
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Credential | DDS
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Telephone | 410-381-4701
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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 | 07868
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License Number State | MD
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