Organization
ENDICOTT DENTAL SURGERY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL P WILSON DDS (OWNER)
(607) 239-6400
Entity
Organization
Contact information
Practice address
609 E MAIN ST STE 9, ENDICOTT, NY 13760-5036
(607) 239-6400
(607) 239-6422
Mailing address
609 E MAIN ST STE 9, ENDICOTT, NY 13760-5036
(607) 239-6400
(607) 239-6422
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
50-052924
NY
Other
Enumeration date
10/05/2010
Last updated
10/05/2010
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