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Individual
JOHN C WILSON
Active
Individual
JOHN C WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7999864-8903
UT
1223G0001X
General Practice Dentistry
Primary
DEN-DEN-LIC-11558
MT
Other
Enumeration date
06/15/2011
Last updated
07/22/2016
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