Provider Demographics
NPI:1659647527
Name:AMY WILSON, DMD, LLC
Entity Type:Organization
Organization Name:AMY WILSON, DMD, LLC
Other - Org Name:WILSON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-647-4705
Mailing Address - Street 1:8318 STOUTS RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:AL
Mailing Address - Zip Code:35116-1424
Mailing Address - Country:US
Mailing Address - Phone:205-647-4705
Mailing Address - Fax:205-647-4775
Practice Address - Street 1:8318 STOUTS RD
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:AL
Practice Address - Zip Code:35116-1424
Practice Address - Country:US
Practice Address - Phone:205-647-4705
Practice Address - Fax:205-647-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL57841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty