Provider Demographics
NPI:1356678775
Name:KANO-WILSON, LUCIANA H (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUCIANA
Middle Name:H
Last Name:KANO-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 1:2525 SANDCREST BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3048
Mailing Address - Country:US
Mailing Address - Phone:812-372-6165
Mailing Address - Fax:812-372-3065
Practice Address - Street 1:2525 SANDCREST BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3048
Practice Address - Country:US
Practice Address - Phone:812-372-6165
Practice Address - Fax:812-372-3065
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011382A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist