Provider Demographics
NPI:1518194901
Name:WILSON, ADRIAN JOHNSTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:JOHNSTON
Last Name:WILSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 RIDGE VIEW LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6278
Mailing Address - Country:US
Mailing Address - Phone:443-280-0968
Mailing Address - Fax:
Practice Address - Street 1:14300 RIDGE VIEW LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-6278
Practice Address - Country:US
Practice Address - Phone:443-280-0968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD147041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry