Wilson, Antionette C

Wilson, Antionette C is an individual health care provider with primary practice located at 2127 E Victory Dr , Savannah GA 31404-3917. She recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Pediatric Dentistry. Dental Providers / Pediatric Dentistry is her primary health care specialty. Wilson, Antionette C can be contacted via phone (912) 443-6013.

Contact Information

Primary practice address
2127 E Victory Dr Savannah GA 31404-3917
Fax: (912) 443-6014
Website:

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X DEN1000575 District of Columbia
Dental Providers / General Practice 1223G0001X 0401411580 Virginia
Dental Providers / General Practice 1223G0001X 13970 Maryland
Dental Providers / Pediatric Dentistry 1223P0221X DN013695 Georgia

Profile Details

NPI number 1437321742
LBN Legal business name Wilson, Antionette C
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 26th, 2008
Last updated Mar 26th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1437321742 NPPES
Georgia Other 2039744 UNITED CONCORDIA
Georgia MEDICAID 428641977A UNITED CONCORDIA
Georgia MEDICAID ZG3695 UNITED CONCORDIA

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