| Wilson Professional Dental Corporation | |
|
31103 Rancho Viejo Rd Ste D5 San Juan Capistrano CA 92675-1759 | |
| (949) 661-3380 | |
| Not Available |
| Full Name | Wilson Professional Dental Corporation |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 31103 Rancho Viejo Rd Ste D5, San Juan Capistrano, California |
| Authorized Official Name and Position | Mandi Lynn Wilson (DENTIST) |
| Authorized Official Contact | 9033304661 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilson Professional Dental Corporation 21020 Pacific City Cir Unit 2423 Huntington Beach CA 92648-8516 Ph: (903) 330-4661 | Wilson Professional Dental Corporation 31103 Rancho Viejo Rd Ste D5 San Juan Capistrano CA 92675-1759 Ph: (949) 661-3380 |
| NPI Number | 1497312888 |
|---|---|
| Provider Enumeration Date | 05/22/2019 |
| Last Update Date | 05/22/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497312888 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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