Individual
DR. JOSEPH A. WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MSD, LLC
Contact information
Practice address
4760 N BUTLER AVE, SUITE A, FARMINGTON, NM 87401-0816
(702) 469-3590
(702) 469-3590
Mailing address
4760 N BUTLER AVE, SUITE A, FARMINGTON, NM 87401-0816
(702) 469-3590
(702) 469-3590
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
49293029922
UT
122300000X
Dentist
DD3399
NM
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
49293029922
UT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DD3399
NM
Other
Enumeration date
11/15/2010
Last updated
02/07/2011
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