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General NPI Number Information
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NPI Number | 1992087282
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Entity Type | Organization
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Legal Business Name | WILSON & WILSON, DDS PLLC
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 1611 KRESKY AVE STE 118
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City | CENTRALIA
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State | WA
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Zip | 98531-8982
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Country | US
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Telephone | 360-736-1114
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Fax |
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Provider Business Mailing Address
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Address Line | 1611 KRESKY AVE STE 118
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City | CENTRALIA
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State | WA
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Zip | 98531-8982
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Country | US
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Telephone | 360-736-1114
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHELLE B WILSON
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Credential | DDS
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Telephone | 360-736-1114
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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 | DE00011026
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License Number State | WA
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