Provider Demographics
NPI:1104086438
Name:WILSON, PATRICK THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:THOMAS
Last Name:WILSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 S DUQUESNE CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-6118
Mailing Address - Country:US
Mailing Address - Phone:720-277-3534
Mailing Address - Fax:
Practice Address - Street 1:9358 DORCHESTER ST STE 106
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2511
Practice Address - Country:US
Practice Address - Phone:303-791-0328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO91841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry