Individual
KIMBERLY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
84 NW 2ND ST, ONTARIO, OR 97914-2412
(541) 889-0052
(541) 889-0900
Mailing address
84 NW 2ND ST, ONTARIO, OR 97914-2412
(541) 889-0052
(541) 889-0900
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H3337
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H3337
DENTAL HYGIENE LICENSE
OR
Enumeration date
06/07/2007
Last updated
07/08/2007
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