Provider Demographics
NPI:1922848902
Name:WILSON, REBECCA PORTER (DDS)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:PORTER
Last Name:WILSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 S SHARON AMITY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3871
Mailing Address - Country:US
Mailing Address - Phone:704-364-9000
Mailing Address - Fax:
Practice Address - Street 1:135 S SHARON AMITY RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3871
Practice Address - Country:US
Practice Address - Phone:704-364-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist