Individual
DR. JOSEPH ROSS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2999 CORPORATE LANE, SUITE B-9, SUFFOLK, VA 23434
(757) 922-8110
(757) 922-8184
Mailing address
2999 CORPORATE LANE, SUITE B-9, SUFFOLK, VA 23434
(757) 922-8110
(757) 922-8184
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401412222
VA
1223G0001X
General Practice Dentistry
D12307
MN
1223P0221X
Pediatric Dentistry
Primary
0401412222
VA
Other
Enumeration date
09/25/2006
Last updated
06/07/2019
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