Individual
DR. JACK L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1721 S CLEVELAND AVE, SUITE 100, SIOUX FALLS, SD 57103-5501
(605) 978-9000
(605) 978-9009
Mailing address
1721 S CLEVELAND AVE, SUITE 100, SIOUX FALLS, SD 57103-5501
(605) 978-9000
(605) 978-9009
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
M470
SD
Other
Enumeration date
08/28/2007
Last updated
03/06/2012
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