Provider Demographics
NPI:1336278266
Name:WILSON, ANNE ROSALIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:ROSALIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13123 E 16TH AVE # B240
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7106
Mailing Address - Country:US
Mailing Address - Phone:720-777-8892
Mailing Address - Fax:720-777-7239
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:B240
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-6788
Practice Address - Fax:720-777-7239
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO60131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02060135Medicaid