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Organization
WILSON DENTAL, PC
Active
Organization
WILSON DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL P WILSON DDS (PRESIDENT/OWNER)
(607) 238-1280
Entity
Organization
Contact information
Practice address
610 S SALINA ST, SYRACUSE, NY 13202-3524
(607) 238-1280
(607) 238-1286
Mailing address
610 S SALINA ST, SYRACUSE, NY 13202-3524
(607) 238-1280
(607) 238-1286
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
50-052924
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02950874
—
NY
Enumeration date
10/13/2010
Last updated
10/13/2010
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