Individual
DR. KYLE JONATHAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
520 POPE AVE, FORT LEAVENWORTH, KS 66027-2332
(913) 684-5516
Mailing address
520 POPE AVE, FORT LEAVENWORTH, KS 66027-2332
(913) 684-5516
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
61861
KS
Other
Enumeration date
06/03/2022
Last updated
03/28/2023
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