Individual
DR. RUSSELL THOMAS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MSD
Contact information
Practice address
602 N CALGARY CT STE 302, POST FALLS, ID 83854-4000
(208) 777-0500
Mailing address
2349 W BASTIEN LOOP, COEUR D ALENE, ID 83815-7602
(307) 389-9143
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D-5563-OR
ID
Other
Enumeration date
09/14/2023
Last updated
05/13/2025
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