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NPI Code Detail

MEDICARE: DR. KAREN CAMILLE WILSON DDS

MEDICARE: DR. KAREN CAMILLE WILSON DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist7982IA

General Provider Information

NPI Number : 1578679015
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KAREN CAMILLE WILSON DDS
Provider Business Mailing Address
First Line : 3605 CENTER POINT RD NE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52402-5571
Country : US
Telephone Number : 319-378-8833
Fax Number : 319-378-8849
Provider Business Practice Location Address
First Line : 3605 CENTER POINT RD NE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52402-5571
Country : US
Telephone Number : 319-378-8833
Fax Number : 319-378-8849
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 07/08/2007

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