Individual
DR. RYAN HASTIIN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6810 MENAUL BLVD NE STE B, ALBUQUERQUE, NM 87110
(505) 872-1100
Mailing address
101 LOS MIRADORES DR NE, RIO RANCHO, NM 87124-4279
(505) 427-8577
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
DD3162
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
270372394
ANOTHER BUSINESS
NM
01
—
455369173
ANOTHER BUSINESS
NM
Enumeration date
06/15/2009
Last updated
07/06/2019
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