Provider Demographics
NPI:1659019511
Name:WILSON, ALLISON KIMBERLY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:KIMBERLY
Last Name:WILSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WILD DEER DR
Mailing Address - Street 2:
Mailing Address - City:STEVENS
Mailing Address - State:PA
Mailing Address - Zip Code:17578-9415
Mailing Address - Country:US
Mailing Address - Phone:717-847-5808
Mailing Address - Fax:
Practice Address - Street 1:100 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2260
Practice Address - Country:US
Practice Address - Phone:717-367-1336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-21
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043592122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist