Organization
CLARENCE J WILSON JR DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLARENCE JAMES WILSON JR. DDS (OWNER PRESIDENT)
(573) 333-1550
Entity
Organization
Contact information
Practice address
109 E 5TH ST, CORUTHERSVILLE, MO 63830
(573) 333-1550
(573) 333-0055
Mailing address
PO BOX 937, 109 E 5TH ST, CARUTHERSVILLE, MO 63830
(573) 333-1550
(573) 333-0055
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13167
MO
Other
Enumeration date
10/31/2006
Last updated
08/22/2020
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