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Individual
BERNADETTE L WILSON
Active
Individual
BERNADETTE L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS MD
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2235
MT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5239
WI
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
11198
MT
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
5239
WI
Other
Enumeration date
09/23/2006
Last updated
02/06/2019
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