MEDICARE: DR. SCOTT P WILSON DDS

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	4273	NV

General Provider Information

NPI Number	:	1700955853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT P WILSON DDS

Provider Business Mailing Address
First Line	:	6015 S FORT APACHE RD
Second Line	:	#130
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5543
Country	:	US
Telephone Number	:	702-485-1780
Fax Number	:	702-485-1078

Provider Business Practice Location Address
First Line	:	6015 S FORT APACHE RD
Second Line	:	#130
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5543
Country	:	US
Telephone Number	:	702-485-1780
Fax Number	:	702-485-1078

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	02/23/2016

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