MEDICARE: CALVIN WILSON, DDS, P.C.

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	:	1871151266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALVIN WILSON, DDS, P.C.

Provider Business Mailing Address
First Line	:	7530 ANNAPOLIS RD
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-1702
Country	:	US
Telephone Number	:	301-918-1951
Fax Number	:

Provider Business Practice Location Address
First Line	:	7530 ANNAPOLIS RD
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-1702
Country	:	US
Telephone Number	:	301-918-1951
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CALVIN WILSON
Credential	:	DDS
Telephone Number	:	301-918-1951

Provider Enumeration Date	:	05/31/2019
Last Update Date	:	01/30/2024

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