Provider Demographics
NPI:1073101093
Name:KRISTEN H FRITZ DDS MS AND M CLIFF WILSON DDS MS
Entity Type:Organization
Organization Name:KRISTEN H FRITZ DDS MS AND M CLIFF WILSON DDS MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CLIFF
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:919-222-1615
Mailing Address - Street 1:363 VILLAGE WALK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7684
Mailing Address - Country:US
Mailing Address - Phone:919-285-4481
Mailing Address - Fax:
Practice Address - Street 1:363 VILLAGE WALK DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7684
Practice Address - Country:US
Practice Address - Phone:919-285-4481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty