Individual
MARK DORSEY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1730 SOUTH CAROLINA - 14, LANDRUM, SC 29356
(864) 457-3425
Mailing address
701 WICKLOW RD, CAMPOBELLO, SC 29322-8423
(864) 266-8526
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DGD10504
SC
Other
Enumeration date
06/22/2023
Last updated
06/22/2023
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