Provider Demographics
NPI:1750502159
Name:WILSON, KATHERINE DUNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:DUNN
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 1:74 STATE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1562
Mailing Address - Country:US
Mailing Address - Phone:303-913-6462
Mailing Address - Fax:
Practice Address - Street 1:74 STATE RD STE 102
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1562
Practice Address - Country:US
Practice Address - Phone:303-913-6462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36711223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics