Scott Paul Wilson, D.D.S.
Individual provider Active NPI Dentist · Greendale, IN
NPI 1932154648 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1932154648
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 12009276 (IN)
- Practice address
- 520 Sheldon St
Greendale, IN 47025-1549 - Phone
- (812) 537-1390
- Fax
- (812) 537-1390
- NPI assigned
- May 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160302002383 | IN | Order and Referring Only - Dentist |
9032415963 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scott P. Wilson D.D.S.P.S.C. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12009276 | IN | Yes |
Addresses
Primary practice location
520 Sheldon St
Greendale, IN 47025-1549
Mailing address
520 Sheldon St
Greendale, IN 47025-1549
Phone (812) 537-1390
Other providers in Greendale, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.