Healthcare Provider Details

I. General information

NPI: 1871313841
Provider Name (Legal Business Name): WAYNE A. LEY, D.D.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8717 MAIN ST
NEEDVILLE TX
77461-8138
US

IV. Provider business mailing address

PO BOX 955
NEEDVILLE TX
77461-0955
US

V. Phone/Fax

Practice location:
  • Phone: 979-793-3366
  • Fax: 979-793-7901
Mailing address:
  • Phone: 979-793-3366
  • Fax: 979-793-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA FRITZ-MAREK
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 979-793-3367