Individual
DR. AVERY M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
412 MALCOLM DR STE 100, WESTMINSTER, MD 21157-6129
(410) 970-0292
Mailing address
412 MALCOLM DR STE 100, WESTMINSTER, MD 21157-6129
(410) 970-0292
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
22DI02819100
NJ
1223P0300X
Periodontics
Primary
17929
MD
1223P0300X
Periodontics
22DI02819100
NJ
Other
Enumeration date
05/12/2020
Last updated
10/20/2023
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