Provider Demographics
NPI:1760406797
Name:WILSON, CHARLES ORIN II (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ORIN
Last Name:WILSON
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27392 CALLE ARROYO
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-6756
Mailing Address - Country:US
Mailing Address - Phone:949-481-5000
Mailing Address - Fax:949-481-9463
Practice Address - Street 1:27392 CALLE ARROYO
Practice Address - Street 2:SUITE A
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-6756
Practice Address - Country:US
Practice Address - Phone:949-481-5000
Practice Address - Fax:949-481-9463
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA226901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice