Individual
WADE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
334 W US HIGHWAY 30 STE G, VALPARAISO, IN 46385-5395
(219) 464-9887
Mailing address
334 W US HIGHWAY 30 STE G, VALPARAISO, IN 46385-5395
(219) 464-9887
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12013223A
IN
Other
Enumeration date
06/26/2019
Last updated
06/26/2019
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