Individual
MICHAEL BRUCE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
600 E 5TH STREET, FULTON STATE HOSPITAL, FULTON, MO 65251
(573) 592-4100
(573) 592-3023
Mailing address
600 E 5TH ST, FULTON, MO 65251-1753
(573) 592-4100
(573) 592-3023
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
014306
MO
Other
Enumeration date
08/10/2006
Last updated
04/19/2026
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