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NPI Code Detail

MEDICARE: DR. ROBIN D WILSON D.M.D

MEDICARE: DR. ROBIN D WILSON D.M.D
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
11223P0221XPediatric Dentistry492SC

General Provider Information

NPI Number : 1598848061
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBIN D WILSON D.M.D
Provider Business Mailing Address
First Line : 105 BARKSDALE GREENE
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-3662
Country : US
Telephone Number : 864-299-0877
Fax Number : 864-250-1604
Provider Business Practice Location Address
First Line : 1376 CLEVELAND ST
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-2435
Country : US
Telephone Number : 864-250-1100
Fax Number : 864-250-1604
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 05/13/2008

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