Healthcare Provider Details

I. General information

NPI: 1003974072
Provider Name (Legal Business Name): KENT WADDELL HEALEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MARTIN LUTHER KING JR BLVD
CHAPEL HILL NC
27514-2619
US

IV. Provider business mailing address

6 SWEETBRIAR LN
CHAPEL HILL NC
27514-9011
US

V. Phone/Fax

Practice location:
  • Phone: 919-942-0651
  • Fax:
Mailing address:
  • Phone: 919-408-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberNC3075
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: