Individual
WILSON TAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
110 TOWN CENTER PKWY STE A, SANTEE, CA 92071-5801
(619) 396-2477
Mailing address
7995 CIVITA BLVD APT 312, SAN DIEGO, CA 92108-5212
(415) 472-9834
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
061312
NY
1223P0221X
Pediatric Dentistry
Primary
103358
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
06/30/2018
Last updated
04/04/2022
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