Provider Demographics
NPI:1306831201
Name:WILSON, TOBY SCOTT (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:TOBY
Middle Name:SCOTT
Last Name:WILSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6877 STATE ROUTE 48
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9782
Mailing Address - Country:US
Mailing Address - Phone:937-886-1458
Mailing Address - Fax:
Practice Address - Street 1:4641 PRESIDENTIAL WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-5765
Practice Address - Country:US
Practice Address - Phone:937-312-1491
Practice Address - Fax:937-312-1914
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
OH30-0213831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics