Provider Demographics
NPI:1427170067
Name:WILSON, SHIRLEY M (DA)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-3308
Mailing Address - Country:US
Mailing Address - Phone:415-956-6610
Mailing Address - Fax:415-956-6618
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:SUITE 2439
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-956-6610
Practice Address - Fax:415-956-6618
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant