Michael Bruce Wilson, DDS

NPI #1336150754 in Fulton, Missouri

Provider Information

NPI Number: 1336150754
Entity Type: Individual
Name: Michael Bruce Wilson, DDS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DDS
Enumeration Date: Aug 10, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 600 E 5TH STREET
Address 2: FULTON STATE HOSPITAL
City: Fulton
State: Missouri
ZIP Code: 65251
Phone: (573) 592-4100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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