Individual
CLAY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
406 SUNRISE AVE # 270, ROSEVILLE, CA 95661-4106
(916) 789-4568
Mailing address
3409 MARINA COVE CIR, ELK GROVE, CA 95758-4669
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
33887
CA
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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