Individual
DR. AMY LEE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
417 UNIVERSITY ST STE 1, TRINIDAD, CO 81082-2560
(719) 846-7387
(719) 846-6297
Mailing address
417 UNIVERSITY ST STE 1, TRINIDAD, CO 81082-2560
(719) 846-7387
(719) 846-6297
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7109
CO
1223G0001X
General Practice Dentistry
Primary
7109
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7109
LICENSE #
CO
Enumeration date
11/22/2006
Last updated
12/22/2008
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