# RC & SA WILSON DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114063443
- **Authorized official:** HEIDI HACKEL (OFFICE MANAGER)
- **Authorized official phone:** (402) 498-8804

## Contact information

- **Practice address:** 13215 BIRCH DR, SUITE 101, OMAHA, NE 68164-5431
- **Practice address phone:** (402) 498-8804
- **Practice address fax:** (402) 498-8838
- **Mailing address:** 13215 BIRCH DR, SUITE 101, OMAHA, NE 68164-5431
- **Mailing address phone:** (402) 498-8804
- **Mailing address fax:** (402) 498-8838

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5060 | NE | Yes |
| 1223G0001X | General Practice Dentistry | 5248 | NE | — |

## Other

- **Enumeration date:** 01/30/2007
- **Last updated:** 06/12/2008