Individual
DR. KELLY BROOKS WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2201 S BLVD, SUITE 210, CHARLOTTE, NC 28203-6208
(704) 333-4760
Mailing address
2904 TEXTILE WAY, CHARLOTTE, NC 28205-1265
(704) 564-3285
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8162
NC
Other
Enumeration date
02/08/2007
Last updated
11/01/2012
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