Individual
JOHN GORDON WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.D.
Contact information
Practice address
715 NICOLE WAY, BAKER CITY, OR 97814-6183
(541) 523-8529
Mailing address
715 NICOLE WAY, BAKER CITY, OR 97814-6183
(541) 523-8529
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DTDO10126518
OR
Other
Enumeration date
12/24/2009
Last updated
02/02/2012
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