Provider Demographics
NPI:1225017338
Name:WILSON, CALVIN JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:JAMES
Last Name:WILSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 OLD WASHINGTON RD STE 301
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3251
Mailing Address - Country:US
Mailing Address - Phone:240-448-6224
Mailing Address - Fax:
Practice Address - Street 1:3450 OLD WASHINGTON RD STE 301
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3251
Practice Address - Country:US
Practice Address - Phone:240-448-6224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN034531223G0001X
MD125451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice