MEDICARE: CAROL E WILKINS D.M.D.

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	14835	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	020014835MA01	OTHER	MA	ANTHEM BLUE CROSS
2	447199	OTHER	MA	UNITED CONCORDIA
3	X05208	OTHER	MA	BLUE CROSS

General Provider Information

NPI Number	:	1326042920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL E WILKINS D.M.D.

Provider Business Mailing Address
First Line	:	401 BROADWAY
Second Line	:
City	:	CHICOPEE
State	:	MA
Zip	:	01020-2454
Country	:	US
Telephone Number	:	413-592-0228
Fax Number	:	413-592-8102

Provider Business Practice Location Address
First Line	:	401 BROADWAY
Second Line	:
City	:	CHICOPEE
State	:	MA
Zip	:	01020-2454
Country	:	US
Telephone Number	:	413-592-0228
Fax Number	:	413-592-8102

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	08/24/2012

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