Individual
DR. MADELYN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
12301 OLIVE BLVD, CREVE COEUR, MO 63141
(314) 579-6166
(314) 579-6163
Mailing address
12301 OLIVE BLVD, CREVE COEUR, MO 63141
(314) 579-6166
(314) 579-6163
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2013020793
MO
Other
Enumeration date
11/05/2013
Last updated
12/12/2016
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