Clarence J Wilson Jr Dds Inc | |
109 E 5th St Coruthersville MO 63830 | |
(573) 333-1550 | |
(573) 333-0055 |
Full Name | Clarence J Wilson Jr Dds Inc |
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Speciality | Dentist - General Practice |
Location | 109 E 5th St, Coruthersville, Missouri |
Authorized Official Name and Position | Clarence James Wilson (OWNER PRESIDENT) |
Authorized Official Contact | 5733331550 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Clarence J Wilson Jr Dds Inc Po Box 937 109 E 5th St Caruthersville MO 63830 Ph: (573) 333-1550 | Clarence J Wilson Jr Dds Inc 109 E 5th St Coruthersville MO 63830 Ph: (573) 333-1550 |
NPI Number | 1780760058 |
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Provider Enumeration Date | 10/31/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1780760058 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 13167 (Missouri) | Primary |