Healthcare Provider Details

I. General information

NPI: 1376249482
Provider Name (Legal Business Name): JOHN WAYAND, DMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 E WILLIAMS ST STE D
APEX NC
27502-2186
US

IV. Provider business mailing address

102 CHATBURN CIR
CARY NC
27513-3445
US

V. Phone/Fax

Practice location:
  • Phone: 919-362-5777
  • Fax:
Mailing address:
  • Phone: 919-699-0490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOHN D WAYAND
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 919-699-0490