| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 10/31/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780760058 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 13167 (Missouri) | Primary |