Provider Demographics
NPI:1730407891
Name:WILSON, RACHEL G (DMD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:G
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 1:2115 ROCKY DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-1370
Mailing Address - Country:US
Mailing Address - Phone:859-987-3290
Mailing Address - Fax:
Practice Address - Street 1:2115 ROCKY DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-1370
Practice Address - Country:US
Practice Address - Phone:859-987-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY89141223G0001X, 122300000X
IN12011736A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist