Individual
DR. JEREMY T WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2301 E LAKE MEAD BLVD, NORTH LAS VEGAS, NV 89030-7137
(702) 331-8338
(702) 639-0579
Mailing address
526 S TONOPAH DR, STE. 200, LAS VEGAS, NV 89106-4043
(702) 291-2031
(702) 366-1483
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5090
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100510344
—
NV
05
—
1023186095
—
NV
Enumeration date
11/30/2006
Last updated
06/15/2016
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