MEDICARE: DR. CALVIN JAMES WILSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DEN03453	RI
2	1223G0001X	General Practice Dentistry	12545	MD

General Provider Information

NPI Number	:	1225017338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CALVIN JAMES WILSON DDS

Provider Business Mailing Address
First Line	:	3450 OLD WASHINGTON RD STE 301
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-3251
Country	:	US
Telephone Number	:	240-448-6224
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 OLD WASHINGTON RD STE 301
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-3251
Country	:	US
Telephone Number	:	240-448-6224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	11/11/2025

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