Individual
COREY J WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
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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