Individual
BENJAMIN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1619 W US HIGHWAY 24, INDEPENDENCE, MO 64050-2345
(816) 461-0055
(816) 503-9404
Mailing address
1619 W US HIGHWAY 24, INDEPENDENCE, MO 64050-2345
(816) 461-0055
(816) 503-9404
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8632
CO
1223G0001X
General Practice Dentistry
Primary
2010033385
MO
1223G0001X
General Practice Dentistry
60918
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790905800
—
MO
Enumeration date
04/30/2007
Last updated
06/05/2014
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