DR. Gary L Wilson, D.M.D.

NPI #1164589743 in Provo, Utah

Provider Information

NPI Number: 1164589743
Entity Type: Individual
Name: DR. Gary L Wilson, D.M.D.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist - General Practice
Credential: D.M.D.
Enumeration Date: Jan 2, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 1355 N UNIVERSITY AVE STE 310
City: Provo
State: Utah
ZIP Code: 84604-2721
Phone: (801) 370-4040

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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