Individual
MR. DAN R WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
813 1/2 COLUMBIA STREET, 813 1/2 COLUMBIA #99, POMEROY, WA 99347
(509) 834-3495
(509) 843-3496
Mailing address
PO BOX 99, POMEROY, WA 99347-0099
(509) 843-3495
(509) 843-3496
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
5974
WA
1223G0001X
General Practice Dentistry
Primary
D1862
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2074241
—
WA
Enumeration date
08/31/2006
Last updated
03/06/2019
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