Individual
DORETHA M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
401 PICACHO RD, WINTERHAVEN, CA 92283-9605
(760) 572-4811
Mailing address
PO BOX 1368, YUMA, AZ 85366-2361
(760) 572-4137
(760) 572-4228
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
3209
KY
Other
Enumeration date
02/17/2023
Last updated
02/17/2023
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