MEDICARE: DR. AMELIA CLAIRE WILSON D.D.S.

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
1	1223G0001X	General Practice Dentistry	5683	NC

General Provider Information

NPI Number	:	1114921855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMELIA CLAIRE WILSON D.D.S.

Provider Business Mailing Address
First Line	:	2415 PENNY RD
Second Line	:	STE 201
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8123
Country	:	US
Telephone Number	:	336-882-9985
Fax Number	:	336-882-8328

Provider Business Practice Location Address
First Line	:	2415 PENNY RD
Second Line	:	STE 201
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8123
Country	:	US
Telephone Number	:	336-882-9985
Fax Number	:	336-882-8328

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	09/18/2007

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