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General NPI Number Information
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NPI Number | 1184680134
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Entity Type | Individual
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Provider Name | JAMES L WILSON DMD
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 207 W FRONT ST
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City | LIBERTY
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State | SC
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Zip | 29657-1009
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Country | US
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Telephone | 864-843-3742
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Fax | 864-843-3744
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Provider Business Mailing Address
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Address Line | 207 W FRONT ST
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City | LIBERTY
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State | SC
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Zip | 29657-1009
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Country | US
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Telephone | 864-843-3742
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Fax | 864-843-3744
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3144
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License Number State | SC
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