Individual
DR. GARY TRENT WILSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6250 POPLAR AVE, MEMPHIS, TN 38119-4713
(901) 681-0011
(901) 681-9725
Mailing address
6250 POPLAR AVE, MEMPHIS, TN 38119-4713
(901) 681-0011
(901) 681-9725
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS8561
TN
Other
Enumeration date
01/18/2010
Last updated
01/18/2010
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