Provider Demographics
NPI:1316229313
Name:WILSON, JENNIFER JOANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JOANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:JOANN
Other - Last Name:DARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5098 BROWN STATION RD # 260
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-9124
Mailing Address - Country:US
Mailing Address - Phone:301-257-6452
Mailing Address - Fax:
Practice Address - Street 1:5098 BROWN STATION RD # 260
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-9124
Practice Address - Country:US
Practice Address - Phone:240-326-3738
Practice Address - Fax:240-545-5500
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD150731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry