# CRISTIN C WILSON DDS

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

## Provider details

- **NPI number:** 1194148312
- **Authorized official:** MRS. DONNA DAUBERT CDA (OFFICE MANAGER)
- **Authorized official phone:** (402) 492-9476

## Contact information

- **Practice address:** 11717 BURT ST, SUITE 100, OMAHA, NE 68154-1500
- **Practice address phone:** (402) 492-9476
- **Practice address fax:** (402) 492-9838
- **Mailing address:** 11717 BURT ST, SUITE 100, OMAHA, NE 68154-1500
- **Mailing address phone:** (402) 492-9476
- **Mailing address fax:** (402) 492-9838

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5740 | NE | Yes |
| 1223G0001X | General Practice Dentistry | 7113 | NE | — |

## Other

- **Enumeration date:** 01/23/2014
- **Last updated:** 01/23/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 10026100400 | — | NE |