Individual
DR. HEATHER WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3111 S KIMBROUGH AVE, SPRINGFIELD, MO 65807-5011
(417) 887-5661
Mailing address
3111 S KIMBROUGH AVE, SPRINGFIELD, MO 65807-5011
(417) 234-2930
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2020003562
MO
Other
Enumeration date
04/24/2018
Last updated
04/14/2020
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