Organization
KEITH J WILSON DDS PC
Active
Other names
FAIR LAKES DENTAL SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH JONATHAN WILSON DDS (OWNER PRESIDENT)
(703) 691-3015
Entity
Organization
Contact information
Practice address
11166 FAIRFAX BLVD STE 400, FAIRFAX, VA 22030-5017
(703) 691-3015
(703) 691-3016
Mailing address
11166 FAIRFAX BLVD STE 400, FAIRFAX, VA 22030-5017
(703) 691-3015
(703) 691-3016
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401008681
VA
Other
Enumeration date
03/21/2007
Last updated
08/22/2020
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