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Individual
DR. SHAWN KEVIN WILSON
Active
Individual
DR. SHAWN KEVIN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
032518
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477636280
CORPORATE NPI
CA
01
—
1811337553
INDIVIDUAL NPI
CA
Enumeration date
06/26/2013
Last updated
10/02/2014
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