Individual
DR. SPENCER GRANT WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1355 S HIGLEY RD, 106, GILBERT, AZ 85296-4799
(480) 279-5949
(480) 279-0784
Mailing address
1355 S HIGLEY RD, 106, GILBERT, AZ 85296-4799
(480) 279-5949
(480) 279-0784
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D0020739
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
502262
—
AZ
Enumeration date
07/06/2006
Last updated
07/13/2007
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