Individual
STEPHEN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
380 BUTTERFLY GARDENS DR, COLUMBUS, OH 43215-7508
(614) 722-5650
Mailing address
700 CHILDRENS DR, COLUMBUS, OH 43205-2664
(614) 722-2000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
30.018004
OH
1223P0221X
Pediatric Dentistry
Primary
30.018004
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0622302
—
OH
Enumeration date
05/22/2006
Last updated
12/09/2021
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