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Individual

DR. KEVIN WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
9521 S WESTERN AVE, CHICAGO, IL 60643-1013
(773) 344-9120
Mailing address
1931 S CLARK ST UNIT C, CHICAGO, IL 60616-1984
(202) 486-3697

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
30.025427
OH
1223G0001X
General Practice Dentistry
Primary
019032065
IL

Other

Enumeration date
05/11/2018
Last updated
10/22/2025
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