Individual
DR. KRISTIN NICOLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
4070 LAVISTA RD STE 102, TUCKER, GA 30084-5228
(770) 225-0723
(770) 491-0037
Mailing address
3897 RIVER RIDGE CT, DECATUR, GA 30034-6902
(404) 906-1552
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DT-2911-0
HI
1223G0001X
General Practice Dentistry
Primary
DN122747
GA
Other
Enumeration date
06/28/2021
Last updated
08/15/2022
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