Organization
SOUTHVIEW DENTISTRY
Active
Other names
South End Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHEAL SCOTT WILSON DDS (DENTIST/OWNER)
(704) 333-4760
Entity
Organization
Contact information
Practice address
2201 SOUTH BLVD, SUITE 210, CHARLOTTE, NC 28203-6204
(704) 333-4760
Mailing address
2201 SOUTH BLVD, SUITE 210, CHARLOTTE, NC 28203-6204
(704) 333-4760
(704) 333-1830
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8162
NC
1223G0001X
General Practice Dentistry
8162
NC
1223G0001X
General Practice Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568522183
NPI
—
01
—
1841330768
NPI
NC
Enumeration date
08/11/2009
Last updated
04/02/2010
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