Healthcare Provider Details

I. General information

NPI: 1598848061
Provider Name (Legal Business Name): ROBIN D WILSON D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1376 CLEVELAND ST
GREENVILLE SC
29607-2435
US

IV. Provider business mailing address

105 BARKSDALE GREENE
GREENVILLE SC
29607-3662
US

V. Phone/Fax

Practice location:
  • Phone: 864-250-1100
  • Fax: 864-250-1604
Mailing address:
  • Phone: 864-299-0877
  • Fax: 864-250-1604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number492
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: