Individual
STEPHANIE M. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
8291 N BOOTH AVE, KANSAS CITY, MO 64158-7202
(816) 728-2979
Mailing address
9018 N SKYVIEW AVE, KANSAS CITY, MO 64154-8501
(816) 741-5113
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2014017372
MO
122300000X
Dentist
61506
KS
1223P0221X
Pediatric Dentistry
Primary
2014017372
MO
Other
Enumeration date
06/13/2014
Last updated
07/30/2019
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