Individual
DR. JACK WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
12320 N 32ND ST, SUITE 1, PHOENIX, AZ 85032-7154
(602) 992-1384
(602) 992-6104
Mailing address
29452 N 49TH WAY, CAVE CREEK, AZ 85331-3323
(480) 262-4412
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D6410
AZ
Other
Enumeration date
12/27/2006
Last updated
07/08/2007
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