Individual
MS. LACY W WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.H.
Contact information
Practice address
1815 HAYNES ST, CLARKSVILLE, TN 37043-4548
(931) 553-6959
(931) 553-8659
Mailing address
1815 HAYNES ST, CLARKSVILLE, TN 37043-4548
(931) 553-6959
(931) 553-8659
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
3095
TN
Other
Enumeration date
01/10/2013
Last updated
01/10/2013
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