Provider Demographics
NPI:1053437095
Name:WILKINSON, ZARA MONIQUE, LEDSIE (DDS)
Entity type:Individual
Prefix:DR
First Name:ZARA
Middle Name:MONIQUE, LEDSIE
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ZARA
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:220 SOUTH WILCOX STREET 53
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3823 GUESS RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-1505
Practice Address - Country:US
Practice Address - Phone:919-479-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8205122300000X
CO002045061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist