Provider Demographics
NPI:1346608585
Name:WILSON, BRITTANY (RDH)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14013 NE 31ST CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2256
Mailing Address - Country:US
Mailing Address - Phone:360-904-0261
Mailing Address - Fax:
Practice Address - Street 1:14013 NE 31ST CT
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2256
Practice Address - Country:US
Practice Address - Phone:360-904-0261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH 60580791124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist