Individual
DR. DOUGLASS CHARLES WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
69 ISLAND ST STE Q, KEENE, NH 03431-3507
(603) 352-0255
(603) 352-6262
Mailing address
69 ISLAND ST STE Q, KEENE, NH 03431-3507
(603) 352-0255
(603) 352-6262
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
016-0002204
VT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
22063
MA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
3428
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000423
—
NH
05
—
1009708
—
VT
Enumeration date
03/14/2007
Last updated
01/20/2010
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