Individual
DESY P WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS, MS
Contact information
Practice address
859 NE 7TH ST, GRANTS PASS, OR 97526-1634
(541) 474-0860
(541) 476-1038
Mailing address
859 NE 7TH ST, GRANTS PASS, OR 97526-1634
(541) 474-0860
(541) 476-1038
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D9823
OR
Other
Enumeration date
10/29/2014
Last updated
10/29/2014
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