Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN17725 | FL |
NPI | 1023196797 |
---|---|
Provider Name | Dr. Cindy Wilson |
First Address | Stuart, FL 34997-4913 |
Second Address | Stuart, FL 34997-4913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 25/11/2008 |