Individual
JERELL JAMES WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
316 MAINE ST, LAWRENCE, KS 66044-1359
(785) 312-7770
(785) 312-9447
Mailing address
1811 ZUMBEHL RD, SAINT CHARLES, MO 63303-2728
(636) 947-1800
(636) 916-0114
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2012015521
MO
Other
Enumeration date
05/31/2012
Last updated
06/30/2014
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