Individual
DR. MICHELLE BERGMANN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1611 KRESKY AVE, SUITE 118, CENTRALIA, WA 98531-8982
(360) 736-1114
Mailing address
1611 KRESKY AVE, SUITE 118, CENTRALIA, WA 98531-8982
(360) 736-1114
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00011026
WA
Other
Enumeration date
07/24/2007
Last updated
07/10/2008
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