Individual
BRUCE T WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
322 HWY 18, MANILA, AR 72442
(870) 561-4400
(870) 561-4037
Mailing address
PO BOX 1345, 322 HWY 18, MANILA, AR 72442-1345
(870) 561-4400
(870) 561-4037
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3179
AR
Other
Enumeration date
12/06/2006
Last updated
07/08/2007
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