Individual
JENNIFER WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
62968 O B RILEY RD STE 12, BEND, OR 97701-9443
(541) 330-6445
(541) 330-6794
Mailing address
21074 PETTIGREW CT, BEND, OR 97702-2423
(541) 610-3728
(541) 330-6794
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H3674
OR
Other
Enumeration date
06/27/2014
Last updated
06/27/2014
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