MEDICARE: DR. CHARLES EDWARD WILKINS III 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	1223P0700X	Prosthodontics	13425	TX

General Provider Information

NPI Number	:	1417050493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES EDWARD WILKINS III DDS

Provider Business Mailing Address
First Line	:	14811 BEAR CREEK PASS
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78737-8937
Country	:	US
Telephone Number	:	512-301-1388
Fax Number	:	512-454-5050

Provider Business Practice Location Address
First Line	:	5020 BURNET RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-2612
Country	:	US
Telephone Number	:	512-454-1010
Fax Number	:	512-454-5050

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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