| NPI | 1184153991 |
|---|---|
| Former Name | NANCY ADALYN WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 0239) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858243) |
| 122300000X Dentist (Licence: SC 9662) | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2022-04-06 |