Individual
JOHN MICHAEL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
110 E NORTH AVE, BONIFAY, FL 32425-1715
(850) 547-9290
(850) 547-4181
Mailing address
110 E NORTH AVE, BONIFAY, FL 32425-1715
(850) 547-9290
(850) 547-4181
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN18106
FL
Other
Enumeration date
08/15/2007
Last updated
08/15/2007
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