Organization
WILSON DENTISTRY LLC
Active
Other names
Image Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JODY WILSON DDS (DENTIST/OWNER)
(317) 551-8040
Entity
Organization
Contact information
Practice address
11711 N PENNSYLVANIA ST, CARMEL, IN 46032-6959
(317) 816-0841
Mailing address
11711 N PENNSYLVANIA ST, CARMEL, IN 46032-6959
(317) 816-0841
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12012331A
IN
Other
Enumeration date
03/30/2017
Last updated
03/30/2017
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