Provider Demographics
NPI:1497478044
Name:WILSON DENTAL
Entity Type:Organization
Organization Name:WILSON DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINBOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-492-9476
Mailing Address - Street 1:11717 BURT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1500
Mailing Address - Country:US
Mailing Address - Phone:402-492-9476
Mailing Address - Fax:
Practice Address - Street 1:11717 BURT ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1500
Practice Address - Country:US
Practice Address - Phone:402-492-9476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental