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General NPI Number Information
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NPI Number | 1750516639
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Entity Type | Organization
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Legal Business Name | NUTTERWILSON PLLC
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Dates
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Enumeration Date | 05/21/2009
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Last Update Date | 05/21/2009
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Provider Practice Location Address
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Address Line | 601 SE 117TH AVE STE 230
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City | VANCOUVER
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State | WA
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Zip | 98683-5297
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Country | US
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Telephone | 360-892-1170
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Fax | 360-604-1172
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Provider Business Mailing Address
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Address Line | 601 SE 117TH AVE STE 230
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City | VANCOUVER
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State | WA
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Zip | 98683-5297
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Country | US
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Telephone | 360-892-1170
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Fax | 360-604-1172
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL E WILSON
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Credential | DMD
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Telephone | 360-892-1170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE000092841
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License Number State | WA
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