Kelley Stewart Wilson, DMD

NPI #1942224332 in Portland, Oregon

Provider Information

NPI Number: 1942224332
Entity Type: Individual
Name: Kelley Stewart Wilson, DMD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - General Practice
Credential: DMD
Enumeration Date: Jul 27, 2006
Last Updated: Sep 7, 2011

Practice Location

Address: 5025 SE 28TH AVE
City: Portland
State: Oregon
ZIP Code: 97202-4445
Phone: (503) 238-4418

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X
Dentist - General Practice — General Practice	1223G0001X	Primary

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