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General NPI Number Information
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NPI Number | 1396482733
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Entity Type | Individual
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Provider Name | KALEI NGUYEN WILSON DDS
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Gender | Female
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Dates
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Enumeration Date | 05/17/2022
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 1300 E CITY ROUTE 40
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City | GREENVILLE
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State | IL
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Zip | 62246-2501
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Country | US
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Telephone | 618-664-1483
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Fax |
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Provider Business Mailing Address
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Address Line | 355 CROWN PT
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City | COLUMBIA
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State | MO
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Zip | 65203-2202
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Country | US
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Telephone | 573-356-1149
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019022749
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License Number State | IL
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