Individual
GAVIN B WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
217 YORK CANYON RD, RATON, NM 87740-2008
(575) 445-8370
Mailing address
217 YORK CANYON RD, RATON, NM 87740-2008
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD4693
NM
Other
Enumeration date
05/31/2017
Last updated
05/31/2017
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