Organization
FISHERS PEAK DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAVIN WILSON DDS (OWNER)
(719) 846-4028
Entity
Organization
Contact information
Practice address
1723 E MAIN ST, TRINIDAD, CO 81082-2017
(719) 846-4028
Mailing address
1723 E MAIN ST, TRINIDAD, CO 81082-2017
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/11/2022
Last updated
04/11/2022
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