Provider Demographics
NPI:1184852188
Name:WILSON, DEBRA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:DEBRA
Other - Middle Name:A
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:108 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6615
Mailing Address - Country:US
Mailing Address - Phone:478-929-2865
Mailing Address - Fax:
Practice Address - Street 1:108 HOLLY DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6615
Practice Address - Country:US
Practice Address - Phone:478-929-2865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9700122300000X
PADS021298L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist