Provider Demographics
NPI:1447390281
Name:WILSON, ALLISON MAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:MAE
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 1:9444 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8666
Mailing Address - Country:US
Mailing Address - Phone:310-600-8090
Mailing Address - Fax:
Practice Address - Street 1:6688 NOLENSVILLE RD STE 104
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8834
Practice Address - Country:US
Practice Address - Phone:615-439-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD54386122300000X
TNDS118320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist