Individual
AMANDA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2134 STATE ROUTE 208, MONTGOMERY, NY 12549-2613
(845) 457-5763
Mailing address
2134 STATE ROUTE 208, MONTGOMERY, NY 12549-2613
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
50058756
NY
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
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