Individual
COREY J WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1522 W MORRIS ST, INDIANAPOLIS, IN 46221-1629
(317) 957-2500
(317) 957-2520
Mailing address
10820 PENDLETON PIKE STE B, INDIANAPOLIS, IN 46236-2952
(317) 597-0184
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12012788A
IN
1223G0001X
General Practice Dentistry
12012788A
IN
1223P0221X
Pediatric Dentistry
Primary
12012788A
IN
Other
Enumeration date
07/11/2017
Last updated
06/04/2024
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