Individual
DR. GUSTAVO D. WILSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6231 S CENTRAL AVE, PHOENIX, AZ 85042-4236
(602) 268-2273
Mailing address
1718 E PRESCOTT DR, CHANDLER, AZ 85249-3199
(480) 775-0863
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D5551
AZ
Other
Enumeration date
05/05/2006
Last updated
07/08/2007
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