Provider Demographics
NPI:1821464686
Name:WILSON, MICHAEL CLIFF (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CLIFF
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 1:111 HOWELL ST APT B
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4819
Mailing Address - Country:US
Mailing Address - Phone:919-222-1615
Mailing Address - Fax:
Practice Address - Street 1:UNC SCHOOL OF DENTISTRY
Practice Address - Street 2:CAMPUS BOX #7450
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-537-3942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice