Provider Demographics
NPI:1265723357
Name:WILSON, LILA PATRICIA (DDS)
Entity type:Individual
Prefix:
First Name:LILA
Middle Name:PATRICIA
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 1:8889 TRILLIUM DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9499
Mailing Address - Country:US
Mailing Address - Phone:734-277-6161
Mailing Address - Fax:
Practice Address - Street 1:8889 TRILLIUM DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9499
Practice Address - Country:US
Practice Address - Phone:734-277-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA603061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice