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Individual
DR. AVERY M WILSON
Active
Individual
DR. AVERY M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
22DI02819100
NJ
1223P0300X
Periodontics
Primary
17929
MD
1223P0300X
Periodontics
22DI02819100
NJ
Other
Enumeration date
05/12/2020
Last updated
10/20/2023
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