Individual
LEIGH G WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
408 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5725
(573) 332-0808
Mailing address
408 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5725
(573) 332-0808
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12011201A
IN
1223G0001X
General Practice Dentistry
Primary
2011019366
MO
Other
Enumeration date
08/13/2008
Last updated
06/28/2012
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