Individual
LOREN G WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1030 4TH ST, ELDORADO, IL 62930-1702
(618) 273-9361
(618) 273-7101
Mailing address
670 BIXLER RD, ELDORADO, IL 62930-3786
(618) 273-9684
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
02/06/2007
Last updated
07/08/2007
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