MEDICARE: DR SCOTT WILSON DDS PLLC 2

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

General Provider Information

NPI Number	:	1720543911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR SCOTT WILSON DDS PLLC 2

Provider Business Mailing Address
First Line	:	2585 S JONES BLVD STE 1B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5604
Country	:	US
Telephone Number	:	702-476-6767
Fax Number	:	702-405-0647

Provider Business Practice Location Address
First Line	:	2585 S JONES BLVD STE 1B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5604
Country	:	US
Telephone Number	:	702-476-6767
Fax Number	:	702-405-0647

Authorized Official
Title or Position	:	OWNER
Name	:	SCOTT WILSON
Credential	:	DDS
Telephone Number	:	702-476-6767

Provider Enumeration Date	:	02/01/2019
Last Update Date	:	02/01/2019

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