Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 9184 | CO |
NPI | 1104086438 |
---|---|
Provider Name | Dr. Patrick Thomas Wilson |
First Address | Aurora, CO 80018-6118 |
Second Address | Highlands Ranch, CO 80129-2511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2008 |
Last Update Date | 07/08/2008 |