Individual
DR. KEITH JONATHAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10590 ENDURING FREEDOM DR, US ARMY DENTAL ACTIVITY, FORT DRUM, NY 13602-5005
(315) 772-6234
Mailing address
10590 ENDURING FREEDOM DR, US ARMY DENTAL ACTIVITY, FORT DRUM, NY 13602-5005
(315) 772-6234
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401008681
VA
Other
Enumeration date
12/04/2006
Last updated
06/13/2016
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