Organization
WILSON PROFESSIONAL DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANDI LYNN WILSON DDS (DENTIST)
(903) 330-4661
Entity
Organization
Contact information
Practice address
31103 RANCHO VIEJO RD STE D5, SAN JUAN CAPISTRANO, CA 92675-1759
(949) 661-3380
Mailing address
21020 PACIFIC CITY CIR UNIT 2423, HUNTINGTON BEACH, CA 92648-8516
(903) 330-4661
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/22/2019
Last updated
05/22/2019
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