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Individual
MR. JACK ANTHONY WILSON
Active
Individual
MR. JACK ANTHONY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RDHAP
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
HAP 299
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
299
REGISTERED DENTAL HYGIENIST IN ALTERNATIVE PRACTICE
CA
Enumeration date
06/24/2005
Last updated
07/15/2014
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