Provider Demographics
NPI:1376066530
Name:WILSON, ALISON (DDS)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name: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 1:1601 N MARTHA CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7358
Mailing Address - Country:US
Mailing Address - Phone:615-426-6277
Mailing Address - Fax:
Practice Address - Street 1:1331 SMITHVILLE HWY
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1422
Practice Address - Country:US
Practice Address - Phone:931-450-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN111541223G0001X
LA68071223G0001X
AZD011612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice