Provider Demographics
NPI:1902827199
Name:KAROLE H WILSON D.M.D., PC
Entity Type:Organization
Organization Name:KAROLE H WILSON D.M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAROLE
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD PC
Authorized Official - Phone:503-245-1915
Mailing Address - Street 1:9370 SW GREENBURG RD STE T
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5408
Mailing Address - Country:US
Mailing Address - Phone:503-245-1915
Mailing Address - Fax:503-245-5956
Practice Address - Street 1:9370 SW GREENBURG RD STE T
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5408
Practice Address - Country:US
Practice Address - Phone:503-245-1915
Practice Address - Fax:503-245-5956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR77531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty