Provider Demographics
NPI:1518192905
Name:WILSON, ANNIE CLAIRE (DDS)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:CLAIRE
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 1:908 W MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-2537
Mailing Address - Country:US
Mailing Address - Phone:817-860-4343
Mailing Address - Fax:817-461-6273
Practice Address - Street 1:908 W MITCHELL ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-2537
Practice Address - Country:US
Practice Address - Phone:817-860-4343
Practice Address - Fax:817-461-6273
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist