Individual
MR. MICHAEL SCOTT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4444 STEEPLETON WAY, CHARLOTTE, NC 28215
(704) 473-4335
Mailing address
100 N TRYON ST, LTCA SUITE B 220 231, CHARLOTTE, NC 28202
(704) 473-4335
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8192
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5904309
—
NC
01
—
8192
DENTAL STATE BOARD
NC
Enumeration date
12/12/2006
Last updated
07/08/2007
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