Provider Demographics
NPI:1679603658
Name:SCOTT P. WILSON D.D.S.P.S.C.
Entity Type:Organization
Organization Name:SCOTT P. WILSON D.D.S.P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-537-3645
Mailing Address - Street 1:520 SHELDON ST
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1549
Mailing Address - Country:US
Mailing Address - Phone:812-537-1390
Mailing Address - Fax:
Practice Address - Street 1:520 SHELDON ST
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:IN
Practice Address - Zip Code:47025-1549
Practice Address - Country:US
Practice Address - Phone:812-537-1390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty