Individual
MRS. BEVERLY A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1303 DR. MARTIN L KING JR AVE, MOBILE, AL 36603
(251) 432-4117
(251) 964-4012
Mailing address
451 CHARLESTON ST, MOBILE, AL 36603
(251) 964-4011
(251) 964-4012
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
LNO3734
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6314000141
—
AL
Enumeration date
10/02/2006
Last updated
04/05/2011
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