Provider Demographics
NPI:1437333291
Name:WILSON, DOREEN CATHERINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:CATHERINE
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 1:1233 EAGLES LANDING PKWY
Mailing Address - Street 2:SUITE J
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6399
Mailing Address - Country:US
Mailing Address - Phone:770-507-1533
Mailing Address - Fax:770-507-1535
Practice Address - Street 1:1233 EAGLES LANDING PKWY
Practice Address - Street 2:SUITE J
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6399
Practice Address - Country:US
Practice Address - Phone:770-507-1533
Practice Address - Fax:770-507-1535
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist