Individual
C THOMAS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
703 S BAY SHORE DR, SUITE #4, SISTER BAY, WI 54234
(920) 854-5200
(920) 854-7601
Mailing address
10589 S HIGHLAND RD, STE 4, SISTER BAY, WI 54234
(920) 854-5200
(920) 854-7601
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1235G
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33495100
—
WI
Enumeration date
05/09/2007
Last updated
07/25/2008
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