Individual
RYAN NEIL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3143 E 29TH AVE, SPOKANE, WA 99223-4815
(509) 536-5900
(509) 534-1015
Mailing address
3143 E 29TH AVE, SPOKANE, WA 99223-4815
(509) 536-5900
(509) 534-1015
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
57421
CA
122300000X
Dentist
Primary
DE60076403
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5059522
—
WA
Enumeration date
09/08/2008
Last updated
10/08/2015
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