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General NPI Number Information
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NPI Number | 1740469014
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Entity Type | Organization
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Legal Business Name | STEVEN L. WILSON, DDS, LLC
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 210 E 30TH AVE SUITE 140
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City | HUTCHINSON
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State | KS
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Zip | 67502-2475
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Country | US
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Telephone | 620-665-5200
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Fax | 620-665-5202
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Provider Business Mailing Address
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Address Line | 210 E 30TH AVE SUITE 140
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City | HUTCHINSON
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State | KS
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Zip | 67502-2475
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Country | US
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Telephone | 620-665-5200
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Fax | 620-665-5202
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN LEE WILSON
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Credential | D.D.S.
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Telephone | 620-665-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 6598
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License Number State | KS
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