Individual
DR. BRIAN LEROY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1801 4TH AVE, CANYON, TX 79015-3853
(806) 655-1104
(806) 655-7453
Mailing address
1801 4TH AVE, CANYON, TX 79015-3853
(806) 655-1104
(806) 655-7453
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
20514
TX
Other
Enumeration date
05/12/2007
Last updated
07/08/2007
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