Provider Demographics
NPI:1215120415
Name:WILSON, ALLYSON N (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:N
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 1:1000 SOUTHPARK BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-5072
Mailing Address - Country:US
Mailing Address - Phone:336-788-5073
Mailing Address - Fax:336-788-1699
Practice Address - Street 1:1000 SOUTHPARK BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-5072
Practice Address - Country:US
Practice Address - Phone:336-788-5073
Practice Address - Fax:336-788-1699
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC84691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice