Provider Demographics
NPI:1497115117
Name:WILSON, ERIN RILEY (DMD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:RILEY
Last Name:WILSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E MILL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:VINEYARD
Mailing Address - State:UT
Mailing Address - Zip Code:84059-5732
Mailing Address - Country:US
Mailing Address - Phone:801-655-5900
Mailing Address - Fax:
Practice Address - Street 1:707 E MILL RD STE 101
Practice Address - Street 2:
Practice Address - City:VINEYARD
Practice Address - State:UT
Practice Address - Zip Code:84059-5732
Practice Address - Country:US
Practice Address - Phone:801-655-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT115023901223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty