Provider Demographics
NPI:1023196797
Name:WILSON, CINDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-4913
Mailing Address - Country:US
Mailing Address - Phone:772-221-3112
Mailing Address - Fax:772-221-3175
Practice Address - Street 1:3305 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-4913
Practice Address - Country:US
Practice Address - Phone:772-221-3112
Practice Address - Fax:772-221-3175
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN177251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry