Individual
DR. LORI S WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3052 MCGEHEE RD, MONTGOMERY, AL 36111-2203
(334) 239-9704
(334) 239-9505
Mailing address
602 FAIRWAY DR, DOTHAN, AL 36301-7860
(757) 635-0497
(804) 733-8687
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401411164
VA
1223G0001X
General Practice Dentistry
D-0006715-C
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1335151
UNITED CONCORDIA
VA
01
—
199459
BLUE CROSS/ BLUE SHIELD
VA
01
—
7996766
AETNA
VA
05
—
9179631
—
VA
Enumeration date
08/01/2006
Last updated
10/31/2023
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