Individual
WILTON CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
829 CHIEF EDDIE HOFFMAN HWY, BETHEL, AK 99559
(907) 543-6100
(907) 543-6159
Mailing address
PO BOX 528, BETHEL, AK 99559-0528
(907) 543-6100
(907) 543-6159
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
125J00000X
Dental Therapist
Primary
25-200-DHAT
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020986
—
AK
Enumeration date
03/18/2022
Last updated
01/27/2025
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