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Organization
CRISTIN C WILSON DDS
Active
Organization
CRISTIN C WILSON DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DONNA DAUBERT CDA (OFFICE MANAGER)
(402) 492-9476
Entity
Organization
Contact information
Practice address
11717 BURT ST, SUITE 100, OMAHA, NE 68154-1500
(402) 492-9476
(402) 492-9838
Mailing address
11717 BURT ST, SUITE 100, OMAHA, NE 68154-1500
(402) 492-9476
(402) 492-9838
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5740
NE
1223G0001X
General Practice Dentistry
7113
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026100400
—
NE
Enumeration date
01/23/2014
Last updated
01/23/2014
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