Richard Lyman Wilson, DDS Valid NPI
Individual provider · Dentist · Ignacio, CO
- NPI
- 1104042761
- Type
- Individual (Type 1)
- Primary specialty
- Dentist
- Specialty group
- Dental Providers
- Taxonomy code
- 122300000X
- License number
- CO7355 (CO)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2007-04-18
- Last updated
- 2014-10-10
Practice location
123 Weeminuche Ave
Ignacio, CO 81137
(970) 563-4581