Individual
DR. GORDON WILSON WOOLLARD
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
1840 BELLRICHARD, CHESSER DENTAL CLINIC, FT POLK, LA 71459
(337) 531-4854
Mailing address
5609 MUDRY CT, FORT POLK, LA 71459-3448
(337) 531-4833
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
5361
NE
Other
Enumeration date
05/11/2006
Last updated
07/08/2007
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