MEDICARE: ETHAN C WILSTON DMD

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	122300000X	Dentist	DS042392	PA

General Provider Information

NPI Number	:	1134785165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN C WILSTON DMD

Provider Business Mailing Address
First Line	:	725 SKIPPACK PIKE STE 125
Second Line	:
City	:	BLUE BELL
State	:	PA
Zip	:	19422-1704
Country	:	US
Telephone Number	:	215-641-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 SKIPPACK PIKE STE 125
Second Line	:
City	:	BLUE BELL
State	:	PA
Zip	:	19422-1704
Country	:	US
Telephone Number	:	215-641-2800
Fax Number	:

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

Provider Enumeration Date	:	05/15/2019
Last Update Date	:	06/04/2026

Similar Medicare Providers

1932466729 — NEUROLOGY PSYCHIATRY AND BALANCE THERAPY CENTER LLC
Practice Location Address:

725 SKIPPACK PIKE , PAREC PLAZA, SUITE 130
BLUE BELL, PA
19422-1704

Practice Phone: 215-591-0700
Practice Fax:

1851024202 — LAUREN YOUNG WILSTON DMD
Practice Location Address:

725 SKIPPACK PIKE STE 125
BLUE BELL, PA
19422-1704

Practice Phone: 215-641-2800
Practice Fax:

1083406136 — WILSTON FAMILY DENTISTRY PLLC
Practice Location Address:

725 SKIPPACK PIKE STE 125
BLUE BELL, PA
19422-1704

Practice Phone: 215-641-2800
Practice Fax:

1265443121 — BILL REEVES M.D
Practice Location Address:

1704 S BLUE BELL RD
BRENHAM, TX
77833-5132

Practice Phone: 979-836-6160
Practice Fax:

1639349129 — MRS. APRIL MAY BRADWAY
Practice Location Address:

1721 BELL RANCH ST
BRANDON, FL
33511-1704

Practice Phone: 813-643-3231
Practice Fax:

1831458066 — NEDDA ALEMI M.D.
Practice Location Address:

1704 W BELL RD
PHOENIX, AZ
85023-3414

Practice Phone: 602-837-5929
Practice Fax:

Directions to “ ETHAN C WILSTON DMD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.