Individual
DR. WYATT WILLIAM WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
19029 BEAVERCREEK RD, OREGON CITY, OR 97045-9537
(503) 941-3064
(503) 941-3075
Mailing address
7320 SW HUNZIKER RD STE 300, PORTLAND, OR 97223-2302
(503) 941-3077
(503) 747-7013
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10058
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500675716
—
OR
Enumeration date
06/23/2014
Last updated
04/20/2020
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