Keith J Wilson DDS PC

NPI #1154447589 in Fairfax, Virginia

Provider Information

NPI Number: 1154447589
Entity Type: Organization
Organization Name: Keith J Wilson DDS PC
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 21, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 11166 FAIRFAX BLVD STE 400
City: Fairfax
State: Virginia
ZIP Code: 22030-5017
Phone: (703) 691-3015

Authorized Official

Name: DR. KEITH JONATHAN WILSON, DDS
Title: OWNER PRESIDENT
Phone: (703) 691-3015

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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