Individual
DR. GARY L WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1355 N UNIVERSITY AVE STE 310, PROVO, UT 84604-2721
(801) 370-4040
Mailing address
1355 N UNIVERSITY AVE STE 310, PROVO, UT 84604-2721
(801) 370-4040
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
276251-9922
UT
Other
Enumeration date
01/02/2007
Last updated
07/08/2007
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