Provider Demographics
NPI:1821204850
Name:WILSON, ROBERT LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOUIS
Last Name:WILSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6634 DELMONICO DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1810
Mailing Address - Country:US
Mailing Address - Phone:719-593-1313
Mailing Address - Fax:719-593-7926
Practice Address - Street 1:6634 DELMONICO DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1810
Practice Address - Country:US
Practice Address - Phone:719-593-1313
Practice Address - Fax:719-593-7926
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1062641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice