Individual
J CALVIN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
317 E NORTH AVE, FLORA, IL 62839-2040
(618) 662-6907
(618) 662-7135
Mailing address
317 E NORTH AVE, FLORA, IL 62839-2040
(618) 662-6907
(618) 662-7135
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019023059
IL
Other
Enumeration date
01/03/2007
Last updated
07/08/2007
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