Individual
DR. LEONARD WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1333 W HARVARD AVE, ROSEBURG, OR 97471-2838
(541) 672-2747
Mailing address
1333 W HARVARD AVE, ROSEBURG, OR 97471-2838
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10244
OR
Other
Enumeration date
06/09/2015
Last updated
06/09/2015
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