Provider Demographics
NPI:1982685590
Name:WILSON, KAY LOUISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAY
Middle Name:LOUISE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 PACKARD ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3874
Mailing Address - Country:US
Mailing Address - Phone:734-662-1591
Mailing Address - Fax:734-662-1599
Practice Address - Street 1:1303 PACKARD ST
Practice Address - Street 2:SUITE #301
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3874
Practice Address - Country:US
Practice Address - Phone:734-662-1591
Practice Address - Fax:734-662-1599
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0145071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry