Individual
SHEA AARON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
750 GRAVOIS BLUFFS BLVD STE C, FENTON, MO 63026-7720
(636) 203-4100
(636) 203-4104
Mailing address
750 GRAVOIS BLUFFS BLVD STE C, FENTON, MO 63026-7720
(636) 203-4100
(636) 203-4104
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2018018837
MO
Other
Enumeration date
06/19/2018
Last updated
06/19/2018
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