Organization
DESY P WILSON DDS MS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESY WILSON (PRESIDENT)
(541) 474-0860
Entity
Organization
Contact information
Practice address
859 NE 7TH ST, GRANTS PASS, OR 97526-1634
(541) 474-0860
Mailing address
2073 SW PARK AVE APT 221, PORTLAND, OR 97201-3121
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
04/11/2013
Last updated
04/11/2013
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