Individual
VANIECIA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
226 WHITEOAK AVE, RALEIGH, MS 39153-6082
(601) 782-9919
Mailing address
76 LAKEWOOD LOOP, HATTIESBURG, MS 39402-9699
(601) 596-2004
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4142-20
MS
Other
Enumeration date
07/15/2020
Last updated
07/15/2020
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