Provider Demographics
NPI:1336352236
Name:WILSON, LOIS S (DDS)
Entity type:Individual
Prefix:DR
First Name:LOIS
Middle Name:S
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 1:25 OAKDALE CT
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5642
Mailing Address - Country:US
Mailing Address - Phone:703-919-2506
Mailing Address - Fax:703-406-9514
Practice Address - Street 1:1447 DOLLEY MADISON BLVD STE C
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6041
Practice Address - Country:US
Practice Address - Phone:703-457-1147
Practice Address - Fax:703-884-1504
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16168122300000X
VA86151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist