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
Phone: (912) 443-6013
Fax: (912) 443-6014
Website:
Health care specialties
Specialty | Code | License # | 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1437321742 | NPPES |
Georgia | Other | 2039744 | UNITED CONCORDIA |
Georgia | MEDICAID | 428641977A | UNITED CONCORDIA |
Georgia | MEDICAID | ZG3695 | UNITED CONCORDIA |
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