Organization
DAN R WILSON DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MERCEDES FIGUEROA (CREDENTIALING SPECIALIST)
(623) 289-3392
Entity
Organization
Contact information
Practice address
638 BRYDEN AVE, LEWISTON, ID 83501-5169
(208) 743-5032
Mailing address
19601 N BLACK CANYON HWY # 201, PHOENIX, AZ 85027-4107
(623) 289-3392
(623) 289-2015
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/04/2024
Last updated
06/04/2024
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