Individual
DR. JOHN RUSSELL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2441 FOOTHILL BLVD, SUITE 1171B, ROCK SPRINGS, WY 82901-5659
(307) 382-5902
Mailing address
325 COLLEGE LN, ROCK SPRINGS, WY 82901-4591
(307) 382-5428
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
888
WY
Other
Enumeration date
05/04/2007
Last updated
07/08/2007
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