| NPI | 1871830851 |
|---|---|
| Doing Business As | DBA WILSON PARK DENTAL |
| Entity Type | Organization |
| Authorized Contact | CHRIS M MALTAVERNE Office Manager 605-343-9352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SD D0812) |
| Enumeration Date | 2013-01-10 |
| Last Update Date | 2013-01-10 |