MEDICARE: DR. NEIL STEVEN WILENSKY 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	19990	CA

General Provider Information

NPI Number	:	1700227576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEIL STEVEN WILENSKY D.D.S.

Provider Business Mailing Address
First Line	:	895 RIVER DR
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-5441
Country	:	US
Telephone Number	:	707-961-4270
Fax Number	:	707-961-4275

Provider Business Practice Location Address
First Line	:	895 RIVER DR
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-5441
Country	:	US
Telephone Number	:	707-961-4270
Fax Number	:	707-961-4275

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

Provider Enumeration Date	:	07/09/2013
Last Update Date	:	07/09/2013

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