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NPI Code Detail

MEDICARE: DR. RONALD E. WILSON D.D.S.

MEDICARE:  DR. RONALD E. 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
11223G0001XGeneral Practice Dentistry7823GA

General Provider Information

NPI Number : 1265565220
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONALD E. WILSON D.D.S.
Provider Business Mailing Address
First Line : 2267 EDGARTOWN LN SE
Second Line :
City : SMYRNA
State : GA
Zip : 30080-6575
Country : US
Telephone Number : 770-433-2820
Fax Number :
Provider Business Practice Location Address
First Line : 1295 TERRELL MILL RD SE
Second Line : SUITE 102
City : MARIETTA
State : GA
Zip : 30067-9438
Country : US
Telephone Number : 770-952-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2007
Last Update Date : 07/08/2007

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Directions to “ DR. RONALD E. WILSON D.D.S.” Practice Location

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