Provider Demographics
NPI:1609909654
Name:RONALD E. WILSON, D.D.S.,P.C.
Entity Type:Organization
Organization Name:RONALD E. WILSON, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC. TREAS.
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-433-2820
Mailing Address - Street 1:2267 EDGARTOWN LN SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6575
Mailing Address - Country:US
Mailing Address - Phone:770-433-2820
Mailing Address - Fax:
Practice Address - Street 1:1295 TERRELL MILL RD SE
Practice Address - Street 2:SUITE 102
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-9438
Practice Address - Country:US
Practice Address - Phone:770-952-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA78231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty