Provider Demographics
NPI:1013033943
Name:WILSON, RON D (DMD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:D
Last Name:WILSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:5415 THOMPSON MILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-4038
Mailing Address - Country:US
Mailing Address - Phone:770-967-8462
Mailing Address - Fax:678-960-0764
Practice Address - Street 1:5415 THOMPSON MILL RD STE A
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-4038
Practice Address - Country:US
Practice Address - Phone:770-967-8462
Practice Address - Fax:678-960-0764
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GADN0129121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics