Individual
DR. GARY ALAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
HIGHWAY 264, MILEPOST 388, POLACCA, AZ 86042-6042
(928) 737-6000
(928) 737-6168
Mailing address
HIGHWAY 264, MP 388, POLACCA, AZ 86042
(928) 737-6000
(928) 737-6168
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
104357
CO
Other
Enumeration date
08/03/2005
Last updated
08/08/2012
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