Individual
DR. DUSTIN C WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
748 W STADIUM BLVD, SUITE 102, JEFFERSON CITY, MO 65109-4752
(573) 634-5122
Mailing address
748 W STADIUM BLVD, SUITE 102, JEFFERSON CITY, MO 65109-4752
(573) 634-5122
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2009013246
MO
Other
Enumeration date
09/08/2011
Last updated
11/18/2016
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