Individual
JOE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4185 CENTENNIAL BLVD, COLORADO SPRINGS, CO 80907-3767
(719) 590-8895
(719) 590-1078
Mailing address
4185 CENTENNIAL BLVD, COLORADO SPRINGS, CO 80907-3767
(719) 590-8895
(719) 590-1078
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
105879
CO
Other
Enumeration date
10/24/2006
Last updated
07/17/2007
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