Provider Demographics
NPI:1558533380
Name:A CLAIRE WILSON DDS PLLC
Entity Type:Organization
Organization Name:A CLAIRE WILSON DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-882-5498
Mailing Address - Street 1:2415 PENNY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8121
Mailing Address - Country:US
Mailing Address - Phone:336-882-5498
Mailing Address - Fax:336-882-8328
Practice Address - Street 1:2415 PENNY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8121
Practice Address - Country:US
Practice Address - Phone:336-882-5498
Practice Address - Fax:336-882-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC99422OtherBCBS
PA518683OtherBCBS
NC8999422Medicaid