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General NPI Number Information
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NPI Number | 1972781375
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Entity Type | Organization
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Legal Business Name | WILSON DENTAL P.C.
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 295 CHENANGO ST
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City | BINGHAMTON
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State | NY
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Zip | 13901-2312
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Country | US
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Telephone | 917-880-1617
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Fax |
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Provider Business Mailing Address
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Address Line | 295 CHENANGO ST
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City | BINGHAMTON
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State | NY
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Zip | 13901-2312
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Country | US
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Telephone | 917-880-1617
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL PATRICK WILSON
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Credential | D.D.S.
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Telephone | 917-880-1617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 052924
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License Number State | NY
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