Provider Demographics
NPI:1578679015
Name:WILSON, KAREN CAMILLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:CAMILLE
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 1:3605 CENTER POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5571
Mailing Address - Country:US
Mailing Address - Phone:319-378-8833
Mailing Address - Fax:319-378-8849
Practice Address - Street 1:3605 CENTER POINT RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5571
Practice Address - Country:US
Practice Address - Phone:319-378-8833
Practice Address - Fax:319-378-8849
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7982122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist