Healthcare Provider Details

I. General information

NPI: 1346722550
Provider Name (Legal Business Name): WESLEY B SMITH DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PRESTON EXECUTIVE DRIVE SUITE 203
CARY NC
27513
US

IV. Provider business mailing address

130 PRESTON EXECUTIVE DRIVE SUITE 203
CARY NC
27513
US

V. Phone/Fax

Practice location:
  • Phone: 919-467-9313
  • Fax: 919-467-5015
Mailing address:
  • Phone: 919-467-9313
  • Fax: 919-467-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: WESLEY BERNARD SMITH
Title or Position: DENTIST
Credential: D.D.S.
Phone: 919-467-9313