Healthcare Provider Details

I. General information

NPI: 1720033863
Provider Name (Legal Business Name): DAVID ALEXANDER WAACK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 SW CARY PARKWAY SUITE 201
CARY NC
27511-6219
US

IV. Provider business mailing address

1505 SW CARY PARKWAY SUITE 201
CARY NC
27511-6219
US

V. Phone/Fax

Practice location:
  • Phone: 919-249-4904
  • Fax: 919-249-4907
Mailing address:
  • Phone: 919-249-4904
  • Fax: 919-249-4907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8156
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: