Individual
ALDOUS B WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1257 BROAD ST, SUMTER, SC 29150-1973
(404) 993-4721
Mailing address
552 WOODBERRY DR, ORANGEBURG, SC 29115-2719
(404) 993-4721
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
011947
GA
1223G0001X
General Practice Dentistry
Primary
3651
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00809025B
—
GA
Enumeration date
10/12/2006
Last updated
05/18/2015
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