Provider Demographics
NPI:1386469252
Name:WILTON, LORA DON (RDH)
Entity type:Individual
Prefix:MRS
First Name:LORA
Middle Name:DON
Last Name:WILTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4897 LOVELADY RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-7619
Mailing Address - Country:US
Mailing Address - Phone:931-309-7509
Mailing Address - Fax:
Practice Address - Street 1:1265 INTERSTATE DR STE 101
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-5198
Practice Address - Country:US
Practice Address - Phone:931-783-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7402124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist