Individual
ANTIONETTE C WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2127 E VICTORY DR, SAVANNAH, GA 31404-3917
(912) 443-6013
(912) 443-6014
Mailing address
2127 E VICTORY DR, SAVANNAH, GA 31404-3917
(912) 443-6013
(912) 443-6014
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
0401411580
VA
1223G0001X
General Practice Dentistry
13970
MD
1223G0001X
General Practice Dentistry
DEN1000575
DC
1223P0221X
Pediatric Dentistry
Primary
DN013695
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2039744
UNITED CONCORDIA
GA
05
—
428641977A
—
GA
05
—
ZG3695
—
SC
Enumeration date
03/26/2008
Last updated
03/26/2015
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