Individual
TROY L WILSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS, PC
Contact information
Practice address
112 GRANT AVE, RATON, NM 87740-2526
(505) 445-8370
(505) 445-3369
Mailing address
PO BOX 981, RATON, NM 87740-0981
(505) 445-8370
(505) 445-3369
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
NM1640
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
88989
—
NM
Enumeration date
10/18/2005
Last updated
07/08/2007
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