Provider Demographics
NPI:1215074240
Name:WILSON, SHARLENE (DDS)
Entity type:Individual
Prefix:DR
First Name:SHARLENE
Middle Name:
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 1:330 SOUTH ALEXANDER
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:NE
Mailing Address - Zip Code:68933
Mailing Address - Country:US
Mailing Address - Phone:402-762-3322
Mailing Address - Fax:
Practice Address - Street 1:13215 BIRCH DR
Practice Address - Street 2:SUITE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-5431
Practice Address - Country:US
Practice Address - Phone:402-498-8804
Practice Address - Fax:402-498-8838
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE50601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice