Provider Demographics
NPI:1497062723
Name:WILSON, KARIN MCCLOSKEY (DDS)
Entity Type:Individual
Prefix:MRS
First Name:KARIN
Middle Name:MCCLOSKEY
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 1:901 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221
Mailing Address - Country:US
Mailing Address - Phone:360-293-8421
Mailing Address - Fax:360-299-6631
Practice Address - Street 1:901 8TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221
Practice Address - Country:US
Practice Address - Phone:360-293-8421
Practice Address - Fax:360-299-6631
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60171633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist