Organization
CAROL A. WILSON, DMD, PLLC
Active
Other names
Jessamine Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAROL ANN WILSON DMD (DENTIST/OWNER)
(859) 885-5703
Entity
Organization
Contact information
Practice address
100 LAKE ST, NICHOLASVILLE, KY 40356-1002
(859) 885-5703
(859) 885-5703
Mailing address
100 LAKE ST, NICHOLASVILLE, KY 40356-1002
(859) 885-5703
(859) 885-5703
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8377
KY
1223G0001X
General Practice Dentistry
8377
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100094910
—
KY
Enumeration date
02/08/2012
Last updated
02/08/2012
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