Individual
GARRETT LEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1606 W MCCLAIN AVE, SCOTTSBURG, IN 47170-1161
(812) 414-4100
Mailing address
1240 CLEO AVE, LOUISVILLE, KY 40213-2342
(502) 602-3748
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12014107A
IN
1223G0001X
General Practice Dentistry
Primary
40869
TX
Other
Enumeration date
01/24/2023
Last updated
08/29/2024
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