# CAROL A. WILSON, DMD, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jessamine Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114299047
- **Authorized official:** DR. CAROL ANN WILSON DMD (DENTIST/OWNER)
- **Authorized official phone:** (859) 885-5703

## Contact information

- **Practice address:** 100 LAKE ST, NICHOLASVILLE, KY 40356-1002
- **Practice address phone:** (859) 885-5703
- **Practice address fax:** (859) 885-5703
- **Mailing address:** 100 LAKE ST, NICHOLASVILLE, KY 40356-1002
- **Mailing address phone:** (859) 885-5703
- **Mailing address fax:** (859) 885-5703

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 8377 | KY | Yes |
| 1223G0001X | General Practice Dentistry | 8377 | KY | — |

## Other

- **Enumeration date:** 02/08/2012
- **Last updated:** 02/08/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100094910 | — | KY |