Individual
DR. JEFFREY DOUGLAS WILSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
13728 OFFICE PARK CT, BAYONET POINT, FL 34667-7144
(727) 863-9669
(727) 862-8907
Mailing address
13728 OFFICE PARK CT, BAYONET POINT, FL 34667-7144
(727) 863-9669
(727) 862-8907
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14685
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
539190
UNITED CONCORDIA
FL
01
—
54987
BLUE CROSS BLUE SHEILD
FL
Enumeration date
06/22/2005
Last updated
07/08/2007
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