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Individual

STEPHEN B WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
3515 DALLAS HWY SW STE B, MARIETTA, GA 30064-2095
(678) 684-8157
Mailing address
41 MIDLAND LN, DALLAS, GA 30157-4133
(843) 540-9790

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
19026680
IL
1223G0001X
General Practice Dentistry
4249
SC
1223G0001X
General Practice Dentistry
Primary
DN013704
GA

Other

Enumeration date
12/16/2005
Last updated
05/01/2012
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