Individual
EDWARD WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
23680 US HIGHWAY 19 N, CLEARWATER, FL 33765-1571
(727) 799-1010
(727) 799-6909
Mailing address
1770 N WICKHAM RD, MELBOURNE, FL 32935-8122
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN11750
FL
Other
Enumeration date
12/13/2006
Last updated
03/23/2020
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