Organization
RYAN H WILSON DDS LLC
Active
Other names
Canyon Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN HASTIIN WILSON D.D.S. (PRESIDENT/OWNER DENTIST)
(505) 278-7007
Entity
Organization
Contact information
Practice address
4760 N BUTLER AVE STE D, FARMINGTON, NM 87401-0816
(505) 278-7007
(505) 325-0817
Mailing address
4760 N BUTLER AVE STE D, FARMINGTON, NM 87401-0816
(505) 278-7007
(505) 325-0817
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD3162
NM
Other
Enumeration date
10/10/2014
Last updated
10/10/2014
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