Provider Demographics
NPI:1598848061
Name:WILSON, ROBIN D (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:D
Last Name:WILSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:105 BARKSDALE GREENE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3662
Mailing Address - Country:US
Mailing Address - Phone:864-299-0877
Mailing Address - Fax:864-250-1604
Practice Address - Street 1:1376 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2435
Practice Address - Country:US
Practice Address - Phone:864-250-1100
Practice Address - Fax:864-250-1604
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry